Review article of medical complications related to adult spinal deformity surgery.
To identify medical complications related to surgery for adult spinal deformity and suggest ways to minimize their occurrence and to avoid them.
Medical complications are a major consideration in adult spinal deformity surgery. Few studies have been done to identify the medical complication rate in relation to these procedures.
We review the literature pertaining to medical complications regarding spinal deformity surgery.
Urinary tract infections are the most frequently seen complication. Additionally, pulmonary complications are the most common life-threatening complication. Medical complications are a frequent occurrence with adult deformity spinal surgery.
Awareness of the presentation, treatment, and prevention of medical complications of deformity surgery may allow minimization of their occurrence and optimize treatment should they occur.
"Adult patients with thoracolumbar degenerative scoliosis generally present with chronic back pain, neurological compromise, and spinal deformity in multiple planes . Open techniques have traditionally been associated with high morbidity and complication rates, despite being effective in achieving sufficient deformity correction  . Therefore, the LLIF has become a viable option for deformity correction and arthrodesis in this patient population. "
"Traditional open surgical correction of adult degenerative scoliosis can be associated with perioperative risk and a prolonged recovery period [8, 12, 17, 19, 20, 29, 40]. Perioperative morbidity is compounded by the complexity of patients with adult degenerative scoliosis as well as patient-specific comorbidities [11, 21, 26, 27, 32]. "
[Show abstract][Hide abstract] ABSTRACT: Minimally invasive surgery (MIS) approaches have the potential to reduce procedure-related morbidity when compared with traditional approaches. However, the magnitude of radiographic correction and degree of clinical improvement with MIS techniques for adult spinal deformity remain undefined.
In this systematic review, we sought to determine whether MIS approaches to adult spinal deformity correction (1) improve pain and function; (2) reliably correct deformity and result in fusion; and (3) are safe with respect to surgical and medical complications.
A systematic review of PubMed and Medline databases was performed for published articles from 1950 to August 2013. A total of 1053 papers were identified. Thirteen papers were selected based on prespecified criteria, including a total of 262 patients. Studies with limited short-term followup (mean, 12.1 months; range, 1.5-39 months) were included to capture early complications. All of the papers included in the review constituted Level IV evidence. Patient age ranged from 20 to 86 years with a mean of 65.8 years. Inclusion and exclusion criteria were variable, but all required at minimum a diagnosis of adult degenerative scoliosis.
Four studies demonstrated improvement in leg/back visual analog scale, three demonstrated improvement in the Oswestry Disability Index, one demonstrated improvement in treatment intensity scale, and one improvement in SF-36. Reported fusion rates ranged from 71.4% to 100% 1 year postoperatively, but only two of 13 papers relied consistently on CT scan to assess fusion, and, interestingly, only four of 10 studies reporting radiographic results on deformity correction found the procedures effective in correcting deformity. There were 115 complications reported among the 258 patients (46%), including 37 neurological complications (14%).
The literature on these techniques is scanty; only two of the 13 studies that met inclusion criteria were considered high quality; CT scans were not generally used to evaluate fusion, deformity correction was inconsistent, and complication rates were high. Future directions for analysis must include comparative trials, longer-term followup, and consistent use of CT scans to assess for fusion to determine the role of MIS techniques for adult spinal deformity.
Clinical Orthopaedics and Related Research 02/2014; 472(6). DOI:10.1007/s11999-013-3441-5 · 2.77 Impact Factor
"Nevertheless, complications represent undesirable consequences of lumbar spine surgery in adult patients. Patients’ age, medical comorbidities and fusion extending up to the sacrum are identified as predisposing risk factors.123456 The development of new guidelines in perioperative nutrition, pulmonary management and intraoperative neuromonitoring have been considered important measures in decreasing the complication rate.78 "
[Show abstract][Hide abstract] ABSTRACT: Surgical treatment of adult lumbar spinal disorders is associated with a substantial risk of intraoperative and perioperative complications. There is no clearly defined medical literature on complication in lumbar spine surgery. Purpose of the study is to retrospectively evaluate intraoperative and perioperative complications who underwent various lumbar surgical procedures and to study the possible predisposing role of advanced age in increasing this rate.
From 2007 to 2011 the number and type of complications were recorded and both univariate, (considering the patients' age) and a multivariate statistical analysis was conducted in order to establish a possible predisposing role. 133 were lumbar disc hernia treated with microdiscetomy, 88 were lumbar stenosis, treated in 36 cases with only decompression, 52 with decompression and instrumentation with a maximum of 2 levels. 26 patients showed a lumbar fracture treated with percutaneous or open screw fixation. 12 showed a scoliotic or kyphotic deformity treated with decompression, fusion and osteotomies with a maximum of 7.3 levels of fusion (range 5-14). 70 were spondylolisthesis treated with 1 or more level of fusion. In 34 cases a fusion till S1 was performed.
Of the 338 patients who underwent surgery, 55 showed one or more complications. Type of surgical treatment (P = 0.004), open surgical approach (open P = 0.001) and operative time (P = 0.001) increased the relative risk (RR) of complication occurrence of 2.3, 3.8 and 5.1 respectively. Major complications are more often seen in complex surgical treatment for severe deformities, in revision surgery and in anterior approaches with an occurrence of 58.3%. Age greater than 65 years, despite an increased RR of perioperative complications (1.5), does not represent a predisposing risk factor to complications (P = 0.006).
Surgical decision-making and exclusion of patients is not justified only by due to age. A systematic preoperative evaluation should always be performed in order to stratify risks and to guide decision-making for obtaining the best possible clinical results at lower risk, even for elderly patients.
Indian Journal of Orthopaedics 07/2013; 47(4):340-5. DOI:10.4103/0019-5413.114909 · 0.64 Impact Factor
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