One-stage major spine deformity correction surgery: comparison between groups with and without additional neurosurgical intervention, with more than 24 months of follow-up

Abstract

Object Early-onset, nonidiopathic spine deformities are frequently caused by intraspinal anomalies necessitating both neurosurgical and orthopedic intervention. The clinical tradition at most treatment units is to perform neurosurgical and orthopedic procedures separately. Sometimes the deformity correction surgery is also done in stages, which leads to several periods of hospitalization, increased use of health care resources, and a long rehabilitation time for the patient. The purpose of this project was to perform an outcome survey for major spine surgery in high-risk patients, and to analyze whether an additional neurosurgical intervention during the same session increased the risk of complications. Methods A consecutive series of 81 patients with major rigid spine deformities treated by the same orthopedic surgeon was analyzed. In 24 of 81 cases there were additional intraspinal pathological entities indicating a neurosurgical procedure. All cases were divided into 2 groups: one with anterior-posterior surgery and also neurosurgery, and the other with anterior-posterior surgery but without neurosurgery. The result variables for the group comparisons were as follows: clinical and radiographic outcome, operating time, length of intensive care and hospital stay, relative blood loss, and occurrence of complications or adverse events. Groups were similar in terms of sex, size of spinal curve, and surgical procedures, but different in terms of diagnosis (there were more patients with myelomeningocele in the group treated with both anterior-posterior surgery and neurosurgery) and patient age (the group with both anterior-posterior surgery and neurosurgery was younger). Results An additional neurosurgical procedure combined with fusion surgery did not increase the complication rate or use of resources compared with fusion surgery alone, except in the length of operating time. The mean correction of the spinal curve was 56.7%, and the mean correction of the pelvic obliquity was 74.7%. The loss of correction was 3° on average. A more than 10° progression was seen in 9 cases. There were no deaths, and there were no neurological complications or surgery-related deterioration of ambulatory function. There were 10 complications that altered the planned postoperative course, including 5 infections. Conclusions One-stage major spine surgery, even when neurosurgery is included, is safe and does not increase the risk of complications. The increase in hospital and ICU stays is marginal.

Single-stage deformity correction in children with neurogenic kyphoscoliosis: nuances and a proposal for risk stratification

“…5 Only a few studies have investigated carrying out single-session surgery for the treatment of both neurogenic and orthopedic problems in these patients. [8][9][10]13 However, the objective evidence to support the staged approach is lacking. 9 Recent studies have questioned the necessity of staging and suggested an alternative approach of single-session surgery.…”

“…9 Recent studies have questioned the necessity of staging and suggested an alternative approach of single-session surgery. 8,10 While comparing concurrent versus staged procedures, Mehta et al 8 found no wound complications or any new onset of neurological deficits in the concurrent-surgery group. They also found that patients in the staged-surgery group had greater blood loss, longer operative time, more wound complications, and longer length of hospital stay.…”

“…A second surgical procedure in a staged approach may entail an increased risk of wound complications due to a poorly healed surgical field and/or poor nutritional status of the patient. [8][9][10] Apart from avoiding these complications, the concurrent-surgery strategy also reduces the total cost of treatment. 8,10 Additionally, studies have found that patients return to full functional status much more rapidly after a concurrent approach.…”

“…[8][9][10] Apart from avoiding these complications, the concurrent-surgery strategy also reduces the total cost of treatment. 8,10 Additionally, studies have found that patients return to full functional status much more rapidly after a concurrent approach. 8,10,13 However, it has been suggested that only selected patients are likely to benefit from such a combined approach.…”

Editorial

“…Albeit challenging in this patient population, intraoperative monitoring is feasible and provides information that may decrease the morbidity associated with surgical intervention. 2,13 In this issue of the Journal of Neurosurgery: Spine, Murans and colleagues 9 report their experience with a large series of 81 patients with complex spine deformities for which correction with a combined anterior-posterior surgical approach between 1997 and 2004 was indicated. Twenty-four of these cases involved an intraspinal pathological entity, necessitating neurosurgical intervention in addition to bone deformity correction.…”