Incidence and Risk Factors for Major Surgical Complications in Patients With Complex Spinal Deformity: A Report From an SRS GOP Site

Abstract

Postoperative complications were seen in 20% of surgically treated patients with complex spine deformities at a Scoliosis Research Society SRS Global Outreach Program site. Three-column osteotomies were identified as an independent risk factor of both postoperative complications and neurological deficits. The significant observed correlation of 3-column osteotomies and postoperative neurological deficits should serve as a guide for surgeons in the preoperative planning and management of severe spinal deformities, especially in locations with limited resources. Patients undergoing correction of large curves may also have a higher complication rate.

Incidence and risk factors of postoperative neurologic decline after complex adult spinal deformity surgery: results of the Scoli-RISK-1 study

“…The reported rate of postoperative neurologic decline after complex ASD surgery in the Scoli-RISK-1 study was higher than that reported in most of the existing literature [5][6][7][8][9][10][11][12][13][14]16,17]. The Scoliosis Research Society Morbidity and Mortality Committee reported that new neurologic deficits after spine surgery, in general, were documented in 1,064 cases (1.0%) in their largest review of 108,419 spinal procedures [22].…”

“…Given the numbers of these events encountered in our cohort, a decision was made to first select 10 variables as candidates to avoid overfitting of the final model [21]. Based on clinical relevance and knowledge from the existing literature, the following 10 variables were chosen: age, previous history of spine surgeries, preoperative neurologic deficits, coronal DAR, sagittal DAR, surgical approach (combined anterior and posterior approach vs. posterior-only approach), numbers of spinal levels involved, lumbar-level osteotomy, 3CO, and estimated blood loss [6][7][8][9][10][11][12][13][14][15][16][17]. Results of univariable analyses are summarized in Table 4.…”

“…For the first step, 10 candidate variables were investigated using univariable logistic regression models. These candidates were selected based on clinical relevance and previous literature [6][7][8][9][10][11][12][13][14][15][16][17]. In the second step, all these variables were entered in a multivariable logistic regression model using backward selection with a retention criterion of p-value of less than .25.…”

“…For instance, spinal osteotomy for rigid deformity is generally believed to be a high-risk procedure, and the severity of the deformity has also been found to be predictive of intraoperative spinal cord monitoring events in a recent study [6]. Only a few modern studies in the literature have documented the risk factors [6][7][8][9][10][11][12][13][14][15][16][17]. The objective of the present study was to elucidate the risk factors associated with neurologic decline after surgical correction of complex ASD.…”

Halo-pelvic traction for severe kyphotic deformity secondary to spinal tuberculosis

“…[4] Failure to treat the spinal tuberculosis could result in severe deformity of the spine, impairment of spinal cord, and failure of respiratory function. [5,6] Although it was once acceptable for patients to live with kyphotic deformity, now most patients hope to achieve close to normal spinal posture with the least invasive treatment method possible. [7] …”