Complication rate in adult deformity surgical treatment: safety of the posterior osteotomies

Maida, Giovanni Andrea La; Luceri, Francesco; Gallozzi, Francesco; Ferraro, Marcello; Misaggi, Bernardo

doi:10.1007/s00586-015-4275-5

Cited by 33 publications

(22 citation statements)

References 18 publications

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“…20,64 It is well recognized that older patients face greater risk for complications with ASD surgery. 22,49,55,66,67 The present study confirms this observation and provides potentially useful benchmarking data for expected complication rates based on patient age. While the rate of overall minor complications was similar across all 3 age groups assessed, the rate of major complications was progressively greater from the young to the middle-age to the elderly patient groups, suggesting that the elderly may be most vulnerable to the more serious complications.…”

Section: Discussionsupporting

confidence: 82%

“…Previous studies that have reported complications for ASD surgery have been limited by many factors, including retrospective design, inclusion of cases from only a single surgeon or single center, inclusion of only short-term complications, limited or poor patient follow-up, and lack of a meticulous or focused effort on recording of complications. 6,14,17,22,30,39,47,51,52,55,58 The present study was designed in an attempt to overcome these limitations, and, in doing so, has provided likely the most complete and detailed reporting of perioperative and delayed ASD surgery complications to date. The findings may prove useful for treatment planning, patient counseling, benchmarking of complication rates, and efforts to improve the safety of patient care.…”

Section: Discussionmentioning

confidence: 99%

“…5,6,25,48,49,[53][54][55][56][57]60 However, these procedures are often complex and may be associated with high rates of complications. 4,6,14,15,17,22,39,44,45,[50][51][52]55,58,61,63 Previously reported studies of ASD surgery complications have been limited by retrospective design, single-surgeon or single-center cohorts, lack of rigorous data on complications, and/or limited follow-up. Improved understanding of the types of complications and their rates of occurrence with ASD surgery, both during the perioperative period and over the course of follow-up, is important for treatment planning, patient counseling, and ongoing efforts to improve the safety of care.…”

mentioning

confidence: 99%

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Prospective multicenter assessment of perioperative and minimum 2-year postoperative complication rates associated with adult spinal deformity surgery

Smith

Klineberg

Lafage

et al. 2016

SPI

300

178

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OBJECTIVE Although multiple reports have documented significant benefit from surgical treatment of adult spinal deformity (ASD), these procedures can have high complication rates. Previously reported complications rates associated with ASD surgery are limited by retrospective design, single-surgeon or single-center cohorts, lack of rigorous data on complications, and/or limited follow-up. Accurate definition of complications associated with ASD surgery is important and may serve as a resource for patient counseling and efforts to improve the safety of patient care. The authors conducted a study to prospectively assess the rates of complications associated with ASD surgery with a minimum 2-year follow-up based on a multicenter study design that incorporated standardized data-collection forms, on-site study coordinators, and regular auditing of data to help ensure complete and accurate reporting of complications. In addition, they report age stratification of complication rates and provide a general assessment of factors that may be associated with the occurrence of complications. METHODS As part of a prospective, multicenter ASD database, standardized forms were used to collect data on surgery-related complications. On-site coordinators and central auditing helped ensure complete capture of complication data. Inclusion criteria were age older than 18 years, ASD, and plan for operative treatment. Complications were classified as perioperative (within 6 weeks of surgery) or delayed (between 6 weeks after surgery and time of last follow-up), and as minor or major. The primary focus for analyses was on patients who reached a minimum follow-up of 2 years. RESULTS Of 346 patients who met the inclusion criteria, 291 (84%) had a minimum 2-year follow-up (mean 2.1 years); their mean age was 56.2 years. The vast majority (99%) had treatment including a posterior procedure, 25% had an anterior procedure, and 19% had a 3-column osteotomy. At least 1 revision was required in 82 patients (28.2%). A total of 270 perioperative complications (145 minor; 125 major) were reported, with 152 patients (52.2%) affected, and a total of 199 delayed complications (62 minor; 137 major) were reported, with 124 patients (42.6%) affected. Overall, 469 complications (207 minor; 262 major) were documented, with 203 patients (69.8%) affected. The most common complication categories included implant related, radiographic, neurological, operative, cardiopulmonary, and infection. Higher complication rates were associated with older age (p = 0.009), greater body mass index (p ≤ 0.031), increased comorbidities (p ≤ 0.007), previous spine fusion (p = 0.029), and 3-column osteotomies (p = 0.036). Cases in which 2-year follow-up was not achieved included 2 perioperative mortalities (pulmonary embolus and inferior vena cava injury). CONCLUSIONS This study provides an assessment of complications associated with ASD surgery based on a prospective, multicenter design and with a minimum 2-year follow-up. Although the overall complication rates were high, in interpreting these findings, it is important to recognize that not all complications are equally impactful. This study represents one of the most complete and detailed reports of perioperative and delayed complications associated with ASD surgery to date. These findings may prove useful for treatment planning, patient counseling, benchmarking of complication rates, and efforts to improve the safety and cost-effectiveness of patient care.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Prospective multicenter assessment of perioperative and minimum 2-year postoperative complication rates associated with adult spinal deformity surgery

Smith

Klineberg

Lafage

et al. 2016

SPI

300

178

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“…Neural injury is relatively low for decompression and fusion [35], but the rate may be significantly higher when osteotomies are performed [17,[36][37][38][39] (Table 1). A retrospective study of 103 ASD patients who underwent posterior arthrodesis of at least seven levels (from the thoracic spine to pelvis) reported a 17 % incidence of new neurologic deficits which persisted at the final follow-up visit [40].…”

Section: Neurologic Complications Based On Surgical Approach Posteriormentioning

confidence: 99%

Neurological complications in adult spinal deformity surgery

Iorio

Reid

Kim

2016

Curr Rev Musculoskelet Med

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The number of surgeries performed for adult spinal deformity (ASD) has been increasing due to an aging population, longer life expectancy, and studies supporting an improvement in health-related quality of life scores after operative intervention. However, medical and surgical complication rates remain high, and neurological complications such as spinal cord injury and motor deficits can be especially debilitating to patients. Several independent factors potentially influence the likelihood of neurological complications including surgical approach (anterior, lateral, or posterior), use of osteotomies, thoracic hyperkyphosis, spinal region, patient characteristics, and revision surgery status. The majority of ASD surgeries are performed by a posterior approach to the thoracic and/or lumbar spine, but anterior and lateral approaches are commonly performed and are associated with unique neural complications such as femoral nerve palsy and lumbar plexus injuries. Spinal morphology, such as that of hyperkyphosis, has been reported to be a risk factor for complications in addition to three-column osteotomies, which are often utilized to correct large deformities. Additionally, revision surgeries are common in ASD and these patients are at an increased risk of procedure-related complications and nervous system injury. Patient selection, surgical technique, and use of intraoperative neuromonitoring may reduce the incidence of complications and optimize outcomes.

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“…[2][3][4] Their use is justified by the importance of sagittal correction in surgeries for deformity, but few articles describe how much of this correction is maintained because of complications that occur and the duration of follow-up in these cases. 5,6 This study surveys the mechanical complications and the evolution of sagittal spinopelvic measurements of a series of 20 patients with sagittal imbalance who underwent three-column osteotomies with follow-up for at least one year.…”

Section: Introductionmentioning

confidence: 99%

Mechanical Complications and Loss of Correction in Osteotomies of the Three Columns

2017

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Objectives: To observe the degree of correction and postoperative evolution of the spinopelvic parameters in patients with sagittal imbalance submitted to 3-column osteotomies. Methods: Retrospective analysis of 20 cases of 3-column osteotomies in patients with evident sagittal imbalance and minimum follow-up of one year, computing evolution of radiological data as a function of time, complications and reinterventions, and classification into subgroups by preoperative spinopelvic measures and complications. The variation of measures, quantitative and categorical variables, and differences between groups were evaluated using the Wilcoxon, Spearman, Fischer's exact test, Kruskal-Wallis and Mann-Whitney tests. Results: There was improvement of all the sagittal parameters, ideal correction in 55% of the cases and maintained until the end of the follow-up in 40% of the cases. No correlation was found between obtaining optimal correction and data or preoperative measurements. Clinical and infectious complications did not affect the maintenance of the correction. The most common mechanical complications were pseudoarthrosis-related rod fracture at osteotomy (30%) and failures at the lower fixation level (15%). There was no significant difference in the maintenance of the correction between the groups with and without mechanical complications treated. In the untreated mechanical complications there was a significantly higher radiological worsening (p<0.05) in the maintenance parameters of the curve correction (loss of 27. MECHANICAL COMPLICATIONS AND LOSS OF CORRECTION IN OSTEOTOMIES OF THE THREE COLUMNS COMPLICAÇÕES MECÂNICAS E PERDA DE CORREÇÃO EM OSTEOTOMIAS DAS TRÊS COLUNAS COMPLICACIONES MECÁNICAS Y PÉRDIDA DE CORRECCIÓN EN OSTEOTOMÍAS DE LAS TRES COLUMNAS

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Complication rate in adult deformity surgical treatment: safety of the posterior osteotomies

Cited by 33 publications

References 18 publications

Prospective multicenter assessment of perioperative and minimum 2-year postoperative complication rates associated with adult spinal deformity surgery

Prospective multicenter assessment of perioperative and minimum 2-year postoperative complication rates associated with adult spinal deformity surgery

Neurological complications in adult spinal deformity surgery

Mechanical Complications and Loss of Correction in Osteotomies of the Three Columns

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