Reoperation After Primary Fusion for Adult Spinal Deformity

Mok, Ji Oh; Cloyd, Jordan M.; Bradford, David S.; Hu, Serena S.; Deviren, Vedat; Smith, Jason A.; Tay, Bobby; Berven, Sigurd

doi:10.1097/brs.0b013e31819f2080

Cited by 159 publications

(131 citation statements)

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“…A review of the literature regarding adult spinal deformity surgery, including studies with sample sizes of at least 40 patients, reveals an overall complication rate lingering around one-third of Treatment was with anterior release and fusion L1-S1 with corpectomies of L3 and L4 and second-stage posterior reconstruction of lordosis and spino-pelvic alignment and posterior fusion T12-S2 using iliac crest bone. Screws in S2 were used to augment the lumbopelvic fixation in the patient with osteoporotic bone cases with revision and subsequent surgeries indicated in one-quarter of patients treated [9,10,13,34,40,44]. Risk factors for failure were elucidated in a report on 144 patients by Kim et al [27]: Besides a thoracolumbar kyphosis and osteoarthritis of the hip, positive postoperative sagittal balance of 5 cm or more, age [55 years, and Explanation of failure in a the patient experienced recurrent sagittal imbalance due to an incomplete correction of the spino-pelvic alignment.…”

Section: Discussionmentioning

confidence: 99%

“…These previous studies on adult spinal deformity surgery serve evidence that spine surgeons might have to expect a revision for complications or subsequent surgeries at or adjacent to the previous instrumentation in one-third of patients on average. Notably, as in the study of Mok [34], adults with neuromuscular diseases were frequently not included or underrepresented in published articles. Likewise, spine literature is reluctant offering sufficient information on adult deformity surgery in patients with neuromuscular diseases.…”

Section: Discussionmentioning

confidence: 99%

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Spinal surgery in patients with Parkinson’s disease: experiences with the challenges posed by sagittal imbalance and the Parkinson’s spine

et al. 2010

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Only a few reports exist concerning biomechanical challenges spine surgeons face when treating Parkinson's disease (PD) patients with spinal deformity. We recognized patients suffering from spinal deformity aggravated by the burden of PD to stress the principles of sagittal balance in surgical treatment. Treatment of sagittal imbalance in PD is difficult due to brittle bone and (the neuromuscular disorder) with postural dysfunction. We performed a retrospective review of 23 PD patients treated surgically for spinal disorders. Mean ASA score was 2.3 (2-3). Outcome analysis included review of medical records focusing on failure characteristics, complications, and radiographic analysis of balance parameters to characterize special risk factors or precautions to be considered in PD patients. The sample included 15 female and 8 male PD patients with mean age of 66.3 years (57-76) at index surgery and 67.9 years (59-76) at follow-up. 10 patients (43.5%) presented with the sequels of failed previous surgery. 18 patients (78.3%) underwent multilevel fusion (C3 level) with 16 patients (69.6%) having fusion to S1, S2 or the Ilium. At a mean follow-up of 14.5 months (1-59) we noted medical complications in 7 patients (30.4%) and surgical complications in 12 patients (52.2%). C7-sagittal center vertical line was 12.2 cm (8-57) preoperatively, 6.9 cm postoperatively, and 7.6 cm at follow-up. Detailed analysis of radiographs, sagittal spinal, and spino-pelvic balance, stressed a positive C7 off-set of 10 cm on average in 25% of patients at follow-up requiring revision surgery in 4 of them. Statistical analysis revealed that patients with a postoperative or follow-up sagittal imbalance (C7-SVL [10 cm) had a significantly increased rate of revision done or scheduled (p = 0.03). Patients with revision surgery as index procedure also were found more likely to suffer postoperative or final sagittal imbalance (C7-SPL, 10 cm; p = 0.008). At all, 33% of patients had any early or late revision performed. Nevertheless, 78% of patients were satisfied or very satisfied with their clinical outcome, while 22% were either not satisfied or uncertain regarding their outcome. The surgical history of PD patients treated for spinal disorders and the reasons necessitating redo surgery for recalcitrant global sagittal imbalance in our sample stressed the mainstays of spinal surgery in Parkinson's: If spinal surgery is indicated, the reconstruction of spinopelvic balance with focus on lumbar lordosis and global sagittal alignment is required.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Spinal surgery in patients with Parkinson’s disease: experiences with the challenges posed by sagittal imbalance and the Parkinson’s spine

et al. 2010

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“…1 Frequent causes of reoperation in this patient population include wound infection/breakdown, implant failure, pseudarthrosis, and removal of instrumentation because of pain. 21,25,29,30 From a patient's standpoint, the high rates of complications and reoperation associated with lumbar deformity surgery are an important factor to be considered in the initial decision to proceed with surgery.…”

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confidence: 99%

Unplanned reoperation after lumbopelvic fixation with S-2 alar-iliac screws or iliac bolts

Mazur¹,

Ravindra²,

Schmidt³

et al. 2015

SPI

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OBJECT S-2 alar-iliac (S2AI) screws are an attractive alternative to conventional fixation with iliac bolts because they are lower profile, require less muscle dissection, and have greater pullout strength. Few studies, however, compare outcomes between these techniques. METHODS The authors conducted a retrospective cohort study of consecutive adult patients at a single institution from December 2009 to March 2012 who underwent lumbopelvic fixation using S2AI screws or iliac bolts. Medical records were reviewed for patients with clinical failure, defined as an unplanned reoperation because of instrumentation failure and/or wound-related complications. Univariate, multivariate, and survival analyses were used to compare patients who required reoperation with those who did not. Method of pelvic fixation was the main predictor variable of interest, and the authors adjusted for potential confounding risk factors. RESULTS Of the 60 patients included, 23 received S2AI screws. Seventeen patients (28%) underwent an osteotomy. The mean follow-up was 22 months. A Kaplan-Meier survival model was used to evaluate the time to reoperation from the initial placement of lumbopelvic instrumentation. The failure-free rate was 96.6% at 6 months, 87.0% at 1 year, and 73.5% at 2 years. Reoperation was more common in patients with iliac bolts than in those with S2AI screws (13 vs 2; p = 0.031). Univariate analysis identified potential risk factors for unplanned reoperation, including use of iliac bolts (p = 0.031), absence of L5–S1 interbody graft (p = 0.048), previous lumbar fusion (p = 0.034), and pathology other than degenerative disease or scoliosis (p = 0.034). After adjusting for other risk factors, multivariate analysis revealed that the use of S2AI screws (OR 8.1 [1.5–73.5]; p = 0.030) was the only independent predictor for preventing unplanned reoperation. CONCLUSIONS Both S2AI screws and iliac bolts were effective at improving fusion rates at the lumbosacral junction. The use of S2AI screws, however, was independently associated with fewer unplanned reoperations for wound-related complications and instrumentation failures than the use of iliac bolts.

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“…[13][14][15] When considering a three-column osteotomy, the decision making process should take the possibility of not achieving sufficient correction or of having postoperative loss of correction into account, [5][6][7][8] since the procedure is subject to various complications and mechanical failures, and may also be impacted by reinterventions that may occur. 16 However, this point is addressed by few articles, which usually originate in centers of excellence where osteotomy procedures have been developed and perfected, and it is not reasonable to expect the technique to spread to smaller centers. 17 Although classical articles show local mobilizations of 30 to 40º with pedicle subtraction, in multicenter studies the average for the same procedure is only 22º.…”

Section: Discussionmentioning

confidence: 99%

“…Infections and mechanical complications, such as junctional kyphosis, pseudoarthrosis, and loosening or fracture of implants, are the most common causes of reinterventions. 4,16 The most frequent mechanical complications in the series was rod breakage, which occurred seven times in six cases (30%), followed by failure of the lower segment of the fixation, which occurred four times in three cases (15%). The cases of lower failure were interpreted as problems with the surgical technique for not having instrumented enough segments.…”

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confidence: 99%

Mechanical Complications and Loss of Correction in Osteotomies of the Three Columns

2017

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Objectives: To observe the degree of correction and postoperative evolution of the spinopelvic parameters in patients with sagittal imbalance submitted to 3-column osteotomies. Methods: Retrospective analysis of 20 cases of 3-column osteotomies in patients with evident sagittal imbalance and minimum follow-up of one year, computing evolution of radiological data as a function of time, complications and reinterventions, and classification into subgroups by preoperative spinopelvic measures and complications. The variation of measures, quantitative and categorical variables, and differences between groups were evaluated using the Wilcoxon, Spearman, Fischer's exact test, Kruskal-Wallis and Mann-Whitney tests. Results: There was improvement of all the sagittal parameters, ideal correction in 55% of the cases and maintained until the end of the follow-up in 40% of the cases. No correlation was found between obtaining optimal correction and data or preoperative measurements. Clinical and infectious complications did not affect the maintenance of the correction. The most common mechanical complications were pseudoarthrosis-related rod fracture at osteotomy (30%) and failures at the lower fixation level (15%). There was no significant difference in the maintenance of the correction between the groups with and without mechanical complications treated. In the untreated mechanical complications there was a significantly higher radiological worsening (p<0.05) in the maintenance parameters of the curve correction (loss of 27. MECHANICAL COMPLICATIONS AND LOSS OF CORRECTION IN OSTEOTOMIES OF THE THREE COLUMNS COMPLICAÇÕES MECÂNICAS E PERDA DE CORREÇÃO EM OSTEOTOMIAS DAS TRÊS COLUNAS COMPLICACIONES MECÁNICAS Y PÉRDIDA DE CORRECCIÓN EN OSTEOTOMÍAS DE LAS TRES COLUMNAS

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Reoperation After Primary Fusion for Adult Spinal Deformity

Cited by 159 publications

References 39 publications

Spinal surgery in patients with Parkinson’s disease: experiences with the challenges posed by sagittal imbalance and the Parkinson’s spine

Spinal surgery in patients with Parkinson’s disease: experiences with the challenges posed by sagittal imbalance and the Parkinson’s spine

Unplanned reoperation after lumbopelvic fixation with S-2 alar-iliac screws or iliac bolts

Mechanical Complications and Loss of Correction in Osteotomies of the Three Columns

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