Factors and Predictive Model Associated With Perioperative Complications After Long Fusion in the Treatment of Adult Non-Degenerative Scoliosis

Abstract

IntroductionAdult non-degenerative scoliosis accounts for 90% of spinal deformities in young adults. However, perioperative complications and related risk factors of long posterior instrumentation and fusion for the treatment of adult non-degenerative scoliosis have not been adequately studied.MethodsWe evaluated clinical and radiographical results from 180 patients with adult non-degenerative scoliosis who underwent long posterior instrumentation and fusion. Preoperative clinical data, intraoperative variables, and perioperative radiographic parameters were collected to analyze the risk factors for perioperative complications. Potential and independent risk factors for perioperative complications were evaluated by univariate analysis and logistic regression analysis.Results180 adult non-degenerative scoliosis patients were included in our study. There were 31 perioperative complications for 25 (13.9%) patients, 11 of which were cardiopulmonary-related complications, five of which were infection, six of which were neurological-related complications, three of which were gastrointestinal-related complications, and six of which were incision-related problems. The independent risk factors for development of perioperative complications included change in Cobb angle (odds ratio [OR]=1.058, 95% CI=1.011~1.108, P=0.015), change in central vertical axis (CVA) (OR=1.066, 95% CI=1.019-1.116, P=0.006) and red blood cell (RBC) transfusion (OR=5.631, 95% CI=1.676~18.924, P=0.005). The area under the receiver operating characteristic (ROC) curve based on predicted probability of the logistic regression was 0.746.ConclusionsBlood transfusion, Cobb change, and CVA change were independent risk factors for perioperative complications after long-segment posterior instrumentation and fusion in adult non-degenerative scoliosis patients.

Difficulties, Challenges, and the Learning Curve of Avoiding Complications in Lumbar Endoscopic Spine Surgery

“…61 First-line treatment should be a minimum 6 week course of intravenous antibiotics. [99][100][101] The antibiotics should only be started after a culture biopsy has been obtained to tailor the regimen to the patient's bacterial culture results. 102 Patients started on empiric antibiotic programs with first-or second-generation cephalosporins may develop antibiotic resistance and a chronic or indolent infection refractory to antibiotic treatment.…”