Medical complications of surgical treatment of adult spinal deformity and how to avoid them

Thomas Jefferson University, Filadelfia, Pennsylvania, United States
Spine (Impact Factor: 2.45). 10/2006; 31(19 Suppl):S106-18. DOI: 10.1097/01.brs.0000232713.69342.df
Source: PubMed

ABSTRACT 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.

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    ABSTRACT: 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.
    Neurosurgical FOCUS 05/2014; 36(5):E18. DOI:10.3171/2014.2.FOCUS1422 · 2.14 Impact Factor
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    ABSTRACT: Object Spinal osteotomies for adult spinal deformity correction may include resection of all 3 spinal columns (pedicle subtraction osteotomy [PSO] and vertebral column resection [VCR]). The relationship between patient age and health-related quality of life (HRQOL) outcomes for patients undergoing major spinal deformity correction via PSO or VCR has not been well characterized. The goal of this study was to characterize that relationship. Methods This study was a retrospective review of 374 patients who had undergone a 3-column osteotomy (299 PSOs and 75 VCRs) and were part of a prospectively collected, multicenter adult spinal deformity database. The consecutively enrolled patients were drawn from 11 sites across the United States. Health-related QOL outcomes, according to the visual analog scale (VAS), Oswestry Disability Index (ODI), 36-Item Short-Form Health Survey (SF-36, physical component score [PCS] and mental component score), and Scoliosis Research Society-22 questionnaire (SRS), were evaluated preoperatively and 1 and 2 years postoperatively. Differences and correlations between patient age and HRQOL outcomes were investigated. Age groupings included young (age ≤ 45 years), middle aged (age 46-64 years), and elderly (age ≥ 65 years). Results In patients who had undergone PSO, age significantly correlated (Spearman's correlation coefficient) with the 2-year ODI (ρ = 0.24, p = 0.0450), 2-year SRS function score (ρ = 0.30, p = 0.0123), and 2-year SRS total score (ρ = 0.30, p = 0.0133). Among all patients (PSO+VCR), the preoperative PCS and ODI in the young group were significantly higher and lower, respectively, than those in the elderly. Among the PSO patients, the elderly group had much greater improvement than the young group in the 1- and 2-year PCS, 2-year ODI, and 2-year SRS function and total scores. Among the VCR patients, the young age group had much greater improvement than the elderly in the 1-year SRS pain score, 1-year PCS, 2-year PCS, and 2-year ODI. There was no significant difference among all the age groups as regards the likelihood of reaching a minimum clinically important difference (MCID) within each of the HRQOL outcomes (p > 0.05 for all). Among the PSO patients, the elderly group was significantly more likely than the young to reach an MCID for the 1-year PCS (61% vs 21%, p = 0.0077) and the 2-year PCS (67% vs 17%, p = 0.0054), SRS pain score (57% vs 20%, p = 0.0457), and SRS function score (62% vs 20%, p = 0.0250). Among the VCR patients, the young group was significantly more likely than the elderly patients to reach an MCID for the 1-year (100% vs 20%, p = 0.0036) and 2-year (100% vs 0%, p = 0.0027) PCS scores and 1-year (60% vs 0%, p = 0.0173) and 2-year (70% vs 0%, p = 0.0433) SRS pain scores. Conclusions The PSO and VCR are not equivalent surgeries in terms of HRQOL outcomes and patient age. Among patients who underwent PSO, the elderly group started with more preoperative disability than the younger patients but had greater improvements in HRQOL outcomes and was more likely to reach an MCID at 1 and 2 years after treatment. Among those who underwent VCR, all had similar preoperative disabilities, but the younger patients had greater improvements in HRQOL outcomes and were more likely to reach an MCID at 1 and 2 years after treatment.
    Journal of neurosurgery. Spine 01/2014; DOI:10.3171/2013.12.SPINE13680 · 2.36 Impact Factor
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    ABSTRACT: Study Design. Retrospective analysis.Objective. To compare radiographic analysis and clinical outcomes of spinal osteotomy techniques, including Smith-Petersen osteotomy (SPO), pedicle subtraction osteotomy (PSO) and vertebral column resection (VCR), and analyze the relationship between preoperative evaluation and postoperative complication incidence.Summary of Background Data. These three techniques have been extensively reported previously, while, few literatures are available on comparing these three techniques in management of severe pediatric spinal deformity.Methods. In all of these 34 pediatric patients, 14 were treated with SPO, 12 were treated with PSO and 8 were treated with VCR. All operations were performed by the senior author beteen 2005 and 2009 in our institute. Preoperative Halo-gravity traction was applied for 2 weeks in all patients, patients were evaluated by standing radiographs taken before and after traction and post operation and a prospectively collected database with ourcomes questionnaires. The postoperative complications and its relationship to preoperative assessment were also analyzed in this study.Results. All these 34 patient were diagnosed as severe pediatric spinal deformity (22 females and 12 males), with an average age of 11.97 years (range, 6-17 years) and an average follow-up of 66.38 months (range, 48-97 months). The mean preoperative major curve for each group was 103.43° in SPO group, 108.08° in PSO group and 117.00° in VCR group, and was corrected to 15.21°, 16.83° and 25.88°, respectively. The apical vertebral translation was corrected by 73.29% by SPO, 73.35% by PSO and 59.71% by VCR. The coronal balance were improved from 16.57 mm to 1.50 mm in SPO group, 17.33 mm to 3.83 mm in PSO group and 29.38 mm to 3.63 mm in VCR group. The mean correction of the kyphotic angle for single SPO was 19.00°, for those with two and three SPOs, the average correction was 34.40° and 47.5°, and 33.83° for the PSO group, 47.38° for VCR group. There were significant improvements in the overall clinical outcomes. The overall complication rate was 35.3%. Complication rate was high in patients with respiratory insufficiency and rigid spine.Conclusion. There was no significant difference in coronal correction among these three techniques, while, the average corrections in the sagittal plane were progressively higher from single SPO to two SPOs or PSO to three SPOs or VCR. Preoperative respiratory insufficiency and rigidity of the spinal deformity are associated with high complication rate.
    Spine 12/2014; DOI:10.1097/BRS.0000000000000728 · 2.45 Impact Factor