Major Complications and Comparison Between 3-Column Osteotomy Techniques in 105 Consecutive Spinal Deformity Procedures

Auerbach, Joshua D.; Lenke, Lawrence G.; Bridwell, Keith H.; Sehn, Jennifer K.; Milby, Andrew H.; Bumpass, David B.; Crawford, Charles H.; OʼShaughnessy, Brian A.; Buchowski, Jacob M.; Chang, Michael S.; Zebala, Lukas P.; Sides, Brenda

doi:10.1097/brs.0b013e31824fffde

Cited by 250 publications

(193 citation statements)

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“…20 Studies have documented the complications that arise, assessing the rates of reoperation, analyzing factors that increase the likelihood of reoperation, and suggesting methods to prevent the need for reoperation. These studies not only reported complications following primary spine surgery 3,8 but also compared complication rates between different types of spine surgeries 14,15 and between primary and revision procedures. 6,11,12 Rates of reoperation are frequently cited, ranging from 10% to 25%, and among the many reasons behind reoperation-including infection, curve progression, proximal junction kyphosis, implant failure, and removal of painful implants 4,13,17 -pseudarthrosis emerges as one of the most commonly documented indications.…”

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confidence: 99%

Reoperation rates and impact on outcome in a large, prospective, multicenter, adult spinal deformity database

Scheer

Tang

Smith

et al. 2013

SPI

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Object Complications and reoperation for surgery to correct adult spinal deformity are not infrequent, and many studies have analyzed the rates and factors that influence the likelihood of reoperation. However, there is a need for more comprehensive analyses of reoperation in adult spinal deformity surgery from a global standpoint, particularly focusing on the 1st year following operation and considering radiographic parameters and the effects of reoperation on health-related quality of life (HRQOL). This study attempts to determine the prevalence of reoperation following surgery for adult spinal deformity, assess the indications for these reoperations, evaluate for a relation between specific radiographic parameters and the need for reoperation, and determine the potential impact of reoperation on HRQOL measures. Methods A retrospective review was conducted of a prospective, multicenter, adult spinal deformity database collected through the International Spine Study Group. Data collected included age, body mass index, sex, date of surgery, information regarding complications, reoperation dates, length of stay, and operation time. The radiographic parameters assessed were total number of levels instrumented, total number of interbody fusions, C-7 sagittal vertical axis, uppermost instrumented vertebra (UIV) location, and presence of 3-column osteotomies. The HRQOL assessment included Oswestry Disability Index (ODI), 36-Item Short Form Health Survey physical component and mental component summary, and SRS-22 scores. Smoking history, Charlson Comorbidity Index scores, and American Society of Anesthesiologists Physical Status classification grades were also collected and assessed for correlation with risk of early reoperation. Various statistical tests were performed for evaluation of specific factors listed above, and the level of significance was set at p < 0.05. Results Fifty-nine (17%) of a total of 352 patients required reoperation. Forty-four (12.5%) of the reoperations occurred within 1 year after the initial surgery, including 17 reoperations (5%) within 30 days. Two hundred sixty-eight patients had a minimum of 1 year of follow-up. Fifty-three (20%) of these patients had a 3-column osteotomy, and 10 (19%) of these 53 required reoperation within 1 year of the initial procedure. However, 3-column osteotomy was not predictive of reoperation within 1 year, p = 0.5476). There were no significant differences between groups with regard to the distribution of UIV, and UIV did not have a significant effect on reoperation rates. Patients needing reoperation within 1 year had worse ODI and SRS-22 scores measured at 1-year follow-up than patients not requiring operation. Conclusions Analysis of data from a large multicenter adult spinal deformity database shows an overall 17% reoperation rate, with a 19% reoperation rate for patients treated with 3-column osteotomy and a 16% reoperation rate for patients not treated with 3-column osteotomy. The most common indications for reoperation included instrumentation complications and radiographic failure. Reoperation significantly affected HRQOL outcomes at 1-year follow-up. The need for reoperation may be minimized by carefully considering spinal alignment, termination of fixation, and type of surgical procedure (presence of osteotomy). Precautions should be taken to avoid malposition or instrumentation (rod) failure.

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confidence: 99%

Reoperation rates and impact on outcome in a large, prospective, multicenter, adult spinal deformity database

Scheer

Tang

Smith

et al. 2013

SPI

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“…Despite variations in techniques, 3COs are effective procedures that allow for the correction of spinal deformity and the restoration of global alignment. 2,4,9,10,26,27 While 3CO procedures are powerful tools in the surgeon's armamentarium for the treatment of spinal deformity, the complexity of these procedures can result in major complications. Analysis of the Scoliosis Research Society morbidity and mortality database showed that patients who underwent osteotomies had higher rates of complications than those who underwent other surgical approaches, and more aggressive osteotomies were associated with higher complication rates.…”

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confidence: 99%

“…20,25 The complication rate for patients undergoing 3CO surgery has been reported to be up to 59%. 2,13,16,17,27 Risk factors for developing major complications have been identified as advanced age, sagittal deformity, preoperative kyphosis, long fusion constructs, 3 or more medical comorbidities, excessive blood loss, and revision surgery. 2,[6][7][8]11,13 While the incidence and risk factors for complications after 3CO have been defined, these definitions have come from primarily single-center studies with small patient populations.…”

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Complications and intercenter variability of three-column osteotomies for spinal deformity surgery: a retrospective review of 423 patients

Bianco

Norton

Schwab

et al. 2014

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112

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Object Three-column resection osteotomies (3COs) are commonly performed for sagittal deformity but have high rates of reported complications. Authors of this study aimed to examine the incidence of and intercenter variability in major intraoperative complications (IOCs), major postoperative complications (POCs) up to 6 weeks postsurgery, and overall complications (that is, both IOCs and POCs). They also aimed to investigate the incidence of and intercenter variability in blood loss during 3CO procedures. Methods The incidence of IOCs, POCs, and overall complications associated with 3COs were retrospectively determined for the study population and for each of 8 participating surgical centers. The incidence of major blood loss (MBL) over 4 L and the percentage of total blood volume lost were also determined for the study population and each surgical center. Complication rates and blood loss were compared between patients with one and those with two osteotomies, as well as between patients with one thoracic osteotomy (ThO) and those with one lumbar or sacral osteotomy (LSO). Risk factors for developing complications were determined. Results Retrospective review of prospectively acquired data for 423 consecutive patients who had undergone 3CO at 8 surgical centers was performed. The incidence of major IOCs, POCs, and overall complications was 7%, 39%, and 42%, respectively, for the study population overall. The most common IOC was spinal cord deficit (2.6%) and the most common POC was unplanned return to the operating room (19.4%). Patients with two osteotomies had more POCs (56% vs 38%, p = 0.04) than the patients with one osteotomy. Those with ThO had more IOCs (16% vs 6%, p = 0.03), POCs (58% vs 34%, p < 0.01), and overall complications (67% vs 37%, p < 0.01) than the patients with LSO. There was significant variation in the incidence of IOCs, POCs, and overall complications among the 8 sites (p < 0.01). The incidence of MBL was 24% for the study population, which varied significantly between sites (p < 0.01). Patients with MBL had a higher risk of IOCs, POCs, and overall complications (OR 2.15, 1.76, and 2.01, respectively). The average percentage of total blood volume lost was 55% for the study population, which also varied among sites (p < 0.01). Conclusions Given the complexity of 3COs for spinal deformity, it is important for spine surgeons to understand the risk factors and complication rates associated with these procedures. In this study, the overall incidence of major complications following 3CO procedures was 42%. Risks for developing complications included an older age (> 60 years), two osteotomies, ThO, and MBL.

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“…1A), and long-segment fusions are associated with complication rates ranging from 10% to 75%. 4,8,10,11,15,19,23,25,30,31,33 Minimally invasive surgery (MIS) for ASD correction has become increasingly popular. As reported by Smith et al, outcome measures after ASD surgery in elderly patients improve more dramatically than in younger patients, and with an increasing elderly population, minimally invasive surgical correction will remain an important option.…”

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confidence: 99%

Complications in adult spinal deformity surgery: an analysis of minimally invasive, hybrid, and open surgical techniques

Uribe

Deukmedjian

Mummaneni³

et al. 2014

FOC

134

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Object It is hypothesized that minimally invasive surgical techniques lead to fewer complications than open surgery for adult spinal deformity (ASD). The goal of this study was to analyze matched patient cohorts in an attempt to isolate the impact of approach on adverse events. Methods Two multicenter databases queried for patients with ASD treated via surgery and at least 1 year of follow-up revealed 280 patients who had undergone minimally invasive surgery (MIS) or a hybrid procedure (HYB; n = 85) or open surgery (OPEN; n = 195). These patients were divided into 3 separate groups based on the approach performed and were propensity matched for age, preoperative sagittal vertebral axis (SVA), number of levels fused posteriorly, and lumbar coronal Cobb angle (CCA) in an attempt to neutralize these patient variables and to make conclusions based on approach only. Inclusion criteria for both databases were similar, and inclusion criteria specific to this study consisted of an age > 45 years, CCA > 20°, 3 or more levels of fusion, and minimum of 1 year of follow-up. Patients in the OPEN group with a thoracic CCA > 75° were excluded to further ensure a more homogeneous patient population. Results In all, 60 matched patients were available for analysis (MIS = 20, HYB = 20, OPEN = 20). Blood loss was less in the MIS group than in the HYB and OPEN groups, but a significant difference was only found between the MIS and the OPEN group (669 vs 2322 ml, p = 0.001). The MIS and HYB groups had more fused interbody levels (4.5 and 4.1, respectively) than the OPEN group (1.6, p < 0.001). The OPEN group had less operative time than either the MIS or HYB group, but it was only statistically different from the HYB group (367 vs 665 minutes, p < 0.001). There was no significant difference in the duration of hospital stay among the groups. In patients with complete data, the overall complication rate was 45.5% (25 of 55). There was no significant difference in the total complication rate among the MIS, HYB, and OPEN groups (30%, 47%, and 63%, respectively; p = 0.147). No intraoperative complications were reported for the MIS group, 5.3% for the HYB group, and 25% for the OPEN group (p < 0.03). At least one postoperative complication occurred in 30%, 47%, and 50% (p = 0.40) of the MIS, HYB, and OPEN groups, respectively. One major complication occurred in 30%, 47%, and 63% (p = 0.147) of the MIS, HYB, and OPEN groups, respectively. All patients had significant improvement in both the Oswestry Disability Index (ODI) and visual analog scale scores after surgery (p < 0.001), although the MIS group did not have significant improvement in leg pain. The occurrence of complications had no impact on the ODI. Conclusions Results in this study suggest that the surgical approach may impact complications. The MIS group had significantly fewer intraoperative complications than did either the HYB or OPEN groups. If the goals of ASD surgery can be achieved, consideration should be given to less invasive techniques.

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Major Complications and Comparison Between 3-Column Osteotomy Techniques in 105 Consecutive Spinal Deformity Procedures

Abstract: Major complications occurred in 35% of 3-column osteotomies and at similar rates for both PSO (38%) and VCR (22%) procedures. The presence of a major complication did not affect the ultimate clinical outcomes at 2 years or more.

Cited by 250 publications

References 28 publications

Reoperation rates and impact on outcome in a large, prospective, multicenter, adult spinal deformity database

Reoperation rates and impact on outcome in a large, prospective, multicenter, adult spinal deformity database

Complications and intercenter variability of three-column osteotomies for spinal deformity surgery: a retrospective review of 423 patients

Complications in adult spinal deformity surgery: an analysis of minimally invasive, hybrid, and open surgical techniques

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