Complications of surgical intervention in adult lumbar scoliosis

Abstract

If nonoperative measures are unsuccessful in managing the pain and disability of adult spinal deformities, surgical correction may provide the potential for significant improvement in a patient's quality of life. However, these procedures have a relatively high risk of complications. Identifying patients that may benefit from surgical intervention requires a thorough understanding of potential complications and managing the risks of any individual patient. Complications do not necessarily result in poor outcomes, and good outcomes are not always complication free. Higher risk patients potentially have more to gain, even if they experience complications. With the rapidly expanding senior population and expanded capabilities to manage high-risk patients, it is helpful to consider the lessons provided by ever expanding databases of outcome measures to refine the surgical decision-making process.

Dural Tears in Adult Deformity Surgery: Incidence, Risk Factors, and Outcomes

“…Complications were classified as major or minor similar to other studies in ASD. 11,12 A complication was classified as major if it prolonged hospitalization, required reoperation or an invasive intervention, caused prolonged or permanent morbidity, or resulted in death. For example, proximal junctional kyphosis requiring revision surgery was classified as a major complication, while proximal junctional kyphosis not requiring surgery was classified as a minor complication.…”

“…For example, proximal junctional kyphosis requiring revision surgery was classified as a major complication, while proximal junctional kyphosis not requiring surgery was classified as a minor complication. The list of minor and major complications was similar to a consensus list prepared by ASD surgeons and presented by Christiansen et al 11 Health-related quality-of-life (HRQOL) data collected at baseline, 6 weeks, and 2 years were analyzed; this included the Oswestry Disability Index (ODI), 36-item Short-Form Health Survey (SF-36; Physical Component Score and Mental Component Score), and the Scoliosis Research Society–22 questionnaire (SRS, subdomains: activity, pain, satisfaction, mental, appearance, and total).…”

Decision Making for Surgery in Adult Scoliosis Review of the Current Literature

“…The presence of comorbidities, like the age, was once perceived as a restrictive factor for surgical intervention. However, this does not necessarily result in poor outcomes in recent literature, and favorable outcomes are not without complications (12,74) . Somehow, higher risk subjects potentially have more to gain, even if they encounter complications (12,50,61) .…”

“…On the other hand, there is the option of "surgical treatment" with up to 80% (9.52%-81.52%) complication rates and more than 50% re-operation rate, reported in several papers (8,9,63,68) . Teles et al (62) reported postoperative radiological (7 main categories) and instrumentrelated (7 main categories) complications and Christiansen et al (12) modified their work and stated 46 major and 41 minor complications under 10 main categories (infection, implantrelated, neurological, cardiopulmonary, gastrointestinal, radiographic, renal, wound problems, operative, and vascular). Surgery may be considered if patients have inadequate improvement with nonoperative measures.…”

“…Patients experiencing complications are significantly older and there is a progressive increase in complication rates with each decade of life 2016 Graham et al (42) Review -Both objective radicular weakness and neurogenic claudication are essentially predictive of a patient with adult spinal deformity choosing to undergo surgery 2016 Pizones et al (40) PR >20°Clinical symptoms, particularly function impairment, motivated patients to undergo surgery. Neither demographic nor radiographic parameters influenced decisionmaking about surgery 2016 Christiansen et al (12) Review -…”