Complications in Spinal Deformity Surgery

Carl, Allen L.; Kaufman, Erin L.; Lawrence, James P.

doi:10.1097/brs.0b013e3181fd591f

Cited by 18 publications

(6 citation statements)

References 99 publications

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“…In 2010 Carl et al [ 3 ] presented a study of 700 spine cases treated surgically and identified a 14% incidence rate of perioperative adverse events, which resulted in a final 3.2% complication rate.…”

Section: Introductionmentioning

confidence: 99%

Update on the neuromonitoring procedures applied during surgeries of the spine – observational study

Daroszewski¹,

Garasz²,

Huber³

et al. 2023

Reumatologia

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IntroductionMotor evoked potentials (MEPs) are currently considered as a more useful method for neurophysi-ological intraoperative monitoring than somatosensory evoked potentials in cases of surgery applied to patients with adolescent idiopathic scoliosis. The non-invasive approach is preferred to modify MEP recordings, criticizing, in many cases, the fundamentalism for neurophysiological monitoring based only on needle recordings. The aim of the review is to provide our own experience and prac-tical guidelines with reference to neuromonitoring innovations.Material and MethodsRecordings of MEPs with surface electrodes instead of needle electrodes including nerve instead of muscle combinations during neurophysiological monitoring associated with surgical interventions to the spine have become more relevant for pediatric purposes, avoiding the anesthesiology-related influences. Observations on 280 patients with Lenke A–C types of spine curvature are presented before and after the surgical correction.ResultsThe MEPs recorded from nerves do not undergo fluctuations at different stages of scoliosis correc-tions and the anesthesia effect more than MEPs recorded from muscles. The use of non-invasive surface electrodes during neuromonitoring for MEP recordings shortens the total time of the surgical procedure without diminishing the precision of the neural transmission evaluation. The quality of MEP recordings during intraoperative neuromonitoring from muscles can be significantly influ-enced by the depth of anesthesia or administration of muscle relaxants but not those recorded from nerves.ConclusionsThe proposed definition of “real-time” neuromonitoring comprises the immediate warning from a neurophysiologist about the changes in a patient’s neurological status during scoliosis surgery (es-pecially during pedicle screws’ implantation, corrective rods’ implantation, correction, distraction and derotation of the spine curvature) exactly during the successive steps of corrective procedures. This is possible due to the simultaneous observation of MEP recordings and a camera image of the surgical field. This procedure clearly increases safety and limits financial claims resulting from possible complications.

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Section: Introductionmentioning

confidence: 99%

Update on the neuromonitoring procedures applied during surgeries of the spine – observational study

Daroszewski¹,

Garasz²,

Huber³

et al. 2023

Reumatologia

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“…2C). EBL was not statistically different between the two groups, which could be explained by the presence of nonmodifiable factors contributing majorly to EBL, including age and comorbidities, and the presence of underlying bleeding disorders 36 …”

Section: Discussionmentioning

confidence: 78%

“…EBL was not statistically different between the two groups, which could be explained by the presence of nonmodifiable factors contributing majorly to EBL, including age and comorbidities, and the presence of underlying bleeding disorders. 36 In addition, patients in the staged group had a higher rate of overall complications and especially VTE. Having a staged spinal fusion surgery increased the risk of VTE (odds ratio = 4) when compared with same-day surgery.…”

Section: Discussionmentioning

confidence: 97%

Same-Day Versus Staged Spinal Fusion: A Meta-analysis of Clinical Outcomes

Daher,

Nassar,

Balmaceno-Criss

et al. 2024

Spine

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Study Design: Meta-Analysis Objective: This meta-analysis aims to compare same-day versus staged spine surgery, assessing their effects on patient care and healthcare system efficiency. Background: In spinal surgery, the debate between whether same-day and staged surgeries are better for patients continues, as the decision may impact patient related outcomes, healthcare resources and overall costs. While some surgeons advocate for staged surgeries citing reduced risks of complications, others proclaim same-day surgeries may minimize costs and length of hospital stays. Methods: PubMed, Cochrane and Google Scholar (Pages 1-20) were searched up until February 2024. The studied outcomes were operative room (OR) time, estimated blood loss (EBL), length of hospital stay (LOS), overall complications, venous thromboembolism (VTE), death, reoperations and non-home discharge. Results: Sixteen retrospective studies were included in this meta-analysis, representing a total of 2346 patients of which 644 underwent staged spinal fusion surgeries and 1702 same-day surgeries. No statistically significant difference was observed in EBL between staged and same-day surgery groups. However, the staged group exhibited a statistically significant longer OR time (P= 0.05) and LOS (P=0.004). A higher rate of overall complications (P=0.002) and VTE (P=0.0008) was significantly associated with the staged group. No significant differences were found in the rates of death, reoperations, and non-home discharge between the two groups. Conclusion: Both staged and same-day spinal fusion surgeries showed comparable rates of death, reoperations and non-home discharges for patients undergoing spinal surgeries. However, given the increased OR time, LOS and complications associated with staged spinal surgeries, this study supports same-day surgeries when possible to minimize the burden on healthcare resources and enhance efficiency.

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“…Traditional open surgery had high complication incidence rate from 20% to 80%, such as pain, swelling of incision, large amount of blood loss, and even death. [ 8 14 53 54 55 ] Several factors were correlated strongly with the incidence of complications, such as age, number of levels operated, and time of operation. [ 20 56 ] MISS could avoid some disadvantages of traditional procedure; it also had certain complications compared to open surgery.…”

Section: Omplications Of M Inimally mentioning

confidence: 99%

Recent Advances in Technique and Clinical Outcomes of Minimally Invasive Spine Surgery in Adult Scoliosis

Liu

Zuo

et al. 2017

Chinese Medical Journal

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Objective:Conventional open spinal surgery of adult scoliosis can be performed from anterior, posterior, or combined approach. Minimally invasive spine surgery (MISS) was developed for the purpose of reducing the undesirable effects and complications. This review aimed to make a brief summary of recent studies of the approach and clinical outcomes of MISS in adult scoliosis.Data Sources:We conducted a systematic search from PubMed, Medline, EMBASE, and other literature databases to collect reports of surgical methods and clinical outcomes of MISS in treatment of adult scoliosis. Those reports were published up to March 2017 with the following key terms: “minimally invasive,” “spine,” “surgery,” and “scoliosis.”Study Selection:The inclusion criteria of the articles were as followings: diagnosed with adult degenerative scoliosis (DS) or adult idiopathic scoliosis; underwent MISS or open surgery; with follow-up data. The articles involving patients with congenital scoliosis or unknown type were excluded and those without any follow-up data were also excluded from the study. The initial search yielded 233 articles. After title and abstract extraction, 29 English articles were selected for full-text review. Of those, 20 studies with 831 patients diagnosed with adult DS or adult idiopathic scoliosis were reviewed. Seventeen were retrospective studies, and three were prospective studies.Results:The surgical technique reported in these articles was direct or extreme lateral interbody fusion, axial lumbar interbody fusion, and transforaminal lumbar interbody fusion. Among the clinical outcomes of these studies, the operated levels was 3–7, operative time was 2.3–8.5 h. Both the Cobb angle of coronal major curve and evaluation of Oswestry Disability Index and Visual Analog Scale decreased after surgery. There were 323 complications reported in the 831 (38.9%) patients, including 150 (18.1%) motor or sensory deficits, and 111 (13.4%) implant-related complications.Conclusions:MISS can provide good radiological and self-evaluation improvement in treatment of adult scoliosis. More prospective studies will be needed before it is widely used.

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Complications in Spinal Deformity Surgery

Abstract: Mundane events can derail a perfectly executed surgical undertaking. Attention to detail, team work, close monitoring, and checklist type focus will help to improve, focus, and avoid these preventable complications that have nothing to do with direct surgical skills.

Cited by 18 publications

References 99 publications

Update on the neuromonitoring procedures applied during surgeries of the spine – observational study

Update on the neuromonitoring procedures applied during surgeries of the spine – observational study

Same-Day Versus Staged Spinal Fusion: A Meta-analysis of Clinical Outcomes

Recent Advances in Technique and Clinical Outcomes of Minimally Invasive Spine Surgery in Adult Scoliosis

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