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Wade SM, Fredericks DR, Elsenbeck MJ, Morrissey PB, Sebastian AS, Kaye ID, Butler JS, Wagner SC. The Incidence, Risk Factors, and Complications Associated With Surgical Delay in Multilevel Fusion for Adult Spinal Deformity. Global Spine J 2022; 12:441-446. [PMID: 32975455 PMCID: PMC9121150 DOI: 10.1177/2192568220954395] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective database review. OBJECTIVES The incidence and risk factors for surgical delay of multilevel spine fusion for adult spinal deformity (ASD), and the complications corresponding therewith, remain unknown. The objectives of this study are to assess the incidence and risk factors for unexpected delay of elective multilevel spinal fusions on the date of surgery as well as the postoperative complications associated with these delays. METHODS We conducted a retrospective review of the ACS-NSQIP database on patients undergoing elective spinal instrumentation of greater than 7 levels for ASD between the years 2005 and 2015. Preoperative risk factors for delay and postoperative complications were compared between the cohorts of patients with and without surgical delays. RESULTS Multivariate analysis of 1570 (15.6%) patients identified advanced age, male sex, American Society of Anesthesiologists (ASA) Class 4, and history of smoking as independent risk factors for delay. Patients experiencing surgical delay demonstrated longer operative times, increased intraoperative bleeding, longer hospitalizations, and significantly higher rates of postoperative complications. Patients experiencing delay demonstrated an almost 7-fold increase in mortality rate (3.4% vs 0.5%, P < .001). CONCLUSIONS Delays in elective surgical care for spinal deformity are negatively related to patient outcomes. Advanced age, male sex, increased ASA class, and a history of smoking cigarettes place patients at risk for surgical delay of multilevel spinal fusion. Patients experiencing surgical delay are at higher risk for postoperative complications, including a 7-fold increase in mortality. These findings suggest that ASD surgery should be postponed in patients experiencing a delay, until modifiable risk factors can be medically optimized, and perhaps postponed indefinitely in those with nonmodifiable risk factors.
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Affiliation(s)
- Sean M. Wade
- Uniformed Services University—Walter Reed National Military Medical Center, Bethesda, MD, USA,Sean M. Wade, Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, America Building, 2nd Floor, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA.
| | - Donald R. Fredericks
- Uniformed Services University—Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Michael J. Elsenbeck
- Uniformed Services University—Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Patrick B. Morrissey
- Naval Medical Center San Diego, San Diego, CA, USA,Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | | | - I. David Kaye
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Joseph S. Butler
- Mater Misericordiae University Hospital, Mater Private Hospital, Dublin, Ireland
| | - Scott C. Wagner
- Uniformed Services University—Walter Reed National Military Medical Center, Bethesda, MD, USA,Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Friedman GN, Benton JA, Echt M, De la Garza Ramos R, Shin JH, Coumans JVCE, Gitkind AI, Yassari R, Leveque JC, Sethi RK, Yanamadala V. Multidisciplinary approaches to complication reduction in complex spine surgery: a systematic review. Spine J 2020; 20:1248-1260. [PMID: 32325247 DOI: 10.1016/j.spinee.2020.04.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 03/30/2020] [Accepted: 04/10/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND CONTEXT Complex spine surgery carries a high complication rate that can produce suboptimal outcomes for patients undergoing these extensive operations. However, multidisciplinary pathways introduced at multiple institutions have demonstrated a promising potential toward reducing the burden of complications in patients being treated for spinal deformities. To date, there has been no effort to systematically collate the multidisciplinary approaches in use at various institutions. PURPOSE The present study aims to determine effective multidisciplinary strategies for reducing the complication rate in complex spine surgery by analyzing existing institutional multidisciplinary approaches and delineating common themes across multiple practice settings. STUDY DESIGN Systematic review. METHODS We followed guidelines established under the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The studies reported on data from PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science and Cochrane. We included articles that described either approaches to, or results from, the implementation of multidisciplinary paradigms during the preoperative, perioperative, and postoperative phases of care for patients undergoing complex spine surgery. We excluded studies that only targeted one complication unless such an approach was in coordination with more extensive multidisciplinary planning at the same institution. RESULTS A total of 406 unique articles were identified. Following an initial determination based on title and abstract, 22 articles met criteria for full-text review, and 10 met the inclusion criteria to be included in the review. Key aspects of multidisciplinary approaches to complex spine surgery included extensive preoperative workup and interdisciplinary conferencing, intraoperative communication and monitoring, and postoperative floor management and discharge planning. These strategies produced decreases in surgical duration and complication rates. CONCLUSIONS This study represents the first to systematically analyze multidisciplinary approaches to reduce complications in complex spine surgery. This review provides a roadmap toward reducing the elevated complication rate for patients undergoing complex spine surgery.
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Affiliation(s)
- Gabriel N Friedman
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Joshua A Benton
- Center for Surgical Optimization, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA; Spinal Disorders Study Group, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA; Department of Physical Medicine and Rehabilitation, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Murray Echt
- Center for Surgical Optimization, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA; Spinal Disorders Study Group, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA; Department of Physical Medicine and Rehabilitation, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Rafael De la Garza Ramos
- Center for Surgical Optimization, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA; Spinal Disorders Study Group, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA; Department of Physical Medicine and Rehabilitation, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - John H Shin
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jean-Valery C E Coumans
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Andrew I Gitkind
- Department of Physical Medicine and Rehabilitation, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Reza Yassari
- Center for Surgical Optimization, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA; Spinal Disorders Study Group, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA; Department of Physical Medicine and Rehabilitation, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | | | - Rajiv K Sethi
- Neuroscience Institute, Virginia Mason Medical Center, Seattle, WA, USA; Department of Health Services, University of Washington, Seattle, WA, USA
| | - Vijay Yanamadala
- Center for Surgical Optimization, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA; Spinal Disorders Study Group, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA; Department of Physical Medicine and Rehabilitation, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA.
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Patel SA, McDonald CL, Reid DBC, DiSilvestro KJ, Daniels AH, Rihn JA. Complications of Thoracolumbar Adult Spinal Deformity Surgery. JBJS Rev 2020; 8:e0214. [PMID: 32427777 DOI: 10.2106/jbjs.rvw.19.00214] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Adult spinal deformity (ASD) is a challenging problem for spine surgeons given the high risk of complications, both medical and surgical.
Surgeons should have a high index of suspicion for medical complications, including cardiac, pulmonary, thromboembolic, genitourinary and gastrointestinal, renal, cognitive and psychiatric, and skin conditions, in the perioperative period and have a low threshold for involving specialists.
Surgical complications, including neurologic injuries, vascular injuries, proximal junctional kyphosis, durotomy, and pseudarthrosis and rod fracture, can be devastating for the patient and costly to the health-care system. Mortality rates have been reported to be between 1.0% and 3.5% following ASD surgery. With the increasing rate of ASD surgery, surgeons should properly counsel patients about these risks and have a high index of suspicion for complications in the perioperative period.
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Kruger KM, Garman CMR, Krzak JJ, Graf A, Hassani S, Tarima S, Sturm PF, Hammerberg KW, Gupta P, Harris GF. Effects of Spinal Fusion for Idiopathic Scoliosis on Lower Body Kinematics During Gait. Spine Deform 2019; 6:441-447. [PMID: 29886917 DOI: 10.1016/j.jspd.2017.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 12/11/2017] [Accepted: 12/15/2017] [Indexed: 11/19/2022]
Abstract
STUDY DESIGN Prospective. OBJECTIVES The purpose of this study was to compare gait among patients with scoliosis undergoing posterior spinal fusion and instrumentation (PSFI) to typically developing subjects and determine if the location of the lowest instrumented vertebra impacted results. SUMMARY OF BACKGROUND DATA PSFI is the standard of care for correcting spine deformities, allowing the preservation of body equilibrium while maintaining as many mobile spinal segments as possible. The effect of surgery on joint motion distal to the spine must also be considered. Very few studies have addressed the effect of PSFI on activities such as walking and even fewer address how surgical choice of the lowest instrumented vertebra (LIV) influences possible motion reduction. METHODS Individuals with scoliosis undergoing PSFI (n = 38) completed gait analysis preoperatively and at postoperative years 1 and 2 along with a control group (n = 24). Comparisons were made with the control group at each time point and between patients fused at L2 and above (L2+) versus L3 and below (L3-). RESULTS The kinematic results of the AIS group showed some differences when compared to the Control Group, most notably decreased range of motion (ROM) in pelvic tilt and trunk lateral bending. When comparing the LIV groups, only minor differences were observed, and the results showed decreased coronal trunk and pelvis ROM at the one-year visit and decreased hip rotation ROM at the two-year visit in the L3- group. CONCLUSIONS Patients with AIS showed decreased ROM preoperatively with further decreases postoperatively. These changes remained relatively consistent following the two-year visit, indicating that most kinematic changes occurred in the first year following surgery. Limited functional differences between the two LIV groups may be due to the lack of full ROM used during normal gait, and future work could address tasks that use greater ROM. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Karen M Kruger
- Orthopaedic & Rehabilitation Engineering Center, Marquette University, 1250 W Wisconsin Ave, Milwaukee, WI 53233, USA.
| | - Christina M R Garman
- Orthopaedic & Rehabilitation Engineering Center, Marquette University, 1250 W Wisconsin Ave, Milwaukee, WI 53233, USA
| | - Joseph J Krzak
- Orthopaedic & Rehabilitation Engineering Center, Marquette University, 1250 W Wisconsin Ave, Milwaukee, WI 53233, USA; Motion Analysis Laboratory, Shriners Hospitals for Children, 2211 N Oak Park Ave, Chicago, IL 60707, USA; College of Health Sciences, Midwestern University, 555 31st, Downers Grove, IL 60515, USA
| | - Adam Graf
- Orthopaedic & Rehabilitation Engineering Center, Marquette University, 1250 W Wisconsin Ave, Milwaukee, WI 53233, USA; Motion Analysis Laboratory, Shriners Hospitals for Children, 2211 N Oak Park Ave, Chicago, IL 60707, USA
| | - Sahar Hassani
- Motion Analysis Laboratory, Shriners Hospitals for Children, 2211 N Oak Park Ave, Chicago, IL 60707, USA
| | - Sergey Tarima
- Division of Biostatistics, Medical College of Wisconsin, 8701 W. Watertown Plank Rd, Milwaukee, WI 53226, USA
| | - Peter F Sturm
- Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229, USA
| | - Kim W Hammerberg
- Motion Analysis Laboratory, Shriners Hospitals for Children, 2211 N Oak Park Ave, Chicago, IL 60707, USA
| | - Purnendu Gupta
- Motion Analysis Laboratory, Shriners Hospitals for Children, 2211 N Oak Park Ave, Chicago, IL 60707, USA
| | - Gerald F Harris
- Orthopaedic & Rehabilitation Engineering Center, Marquette University, 1250 W Wisconsin Ave, Milwaukee, WI 53233, USA; Motion Analysis Laboratory, Shriners Hospitals for Children, 2211 N Oak Park Ave, Chicago, IL 60707, USA
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Dynamic Fluctuation of Truncal Shift Parameters During Quiet Standing in Healthy Young Individuals. Spine (Phila Pa 1976) 2018; 43:E746-E751. [PMID: 29215505 DOI: 10.1097/brs.0000000000002521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective analysis. OBJECTIVE To describe the dynamic fluctuation of truncal shift parameters during quiet standing in healthy young individuals using biomechanical analyses. SUMMARY OF BACKGROUND DATA Coronal decompensation (CD) and sagittal vertical axis (SVA) are the key radiographic parameters to assess static truncal stability, with the known cut-off value of 4 cm for SVA in determining severity of spinal deformity. These values are obtained at a specific moment during quiet standing, when the posture innately changes. Thus, unassessed truncal sway could potentially compromise the reliability of these measurements. METHODS Previously obtained biomechanical data with 11 male, healthy participants aged 16 to 29 were used to quantify the dynamic sway of standing posture. The participants were instructed to quietly stand with surface reflective markers for 130 seconds. The midpoint of bilateral acromia was used as a surrogate for C7 vertebral body. The time series of coronal and sagittal shifts of C7 to sacrum were measured as quasi-coronal decompensation (CD) and quasi-sagittal vertical axis (SVA) to simulate CD and SVA on radiographs. A force platform was also used to measure the center of pressure (COP) displacement. RESULTS The group averages of the dynamic sway range were 20.2 ± 4.1 mm (range: 15.1-28.6) in the sagittal plane (quasi-SVA) and 9.8 ± 3.2 mm (range: 5.5-15.2) in the coronal plane (quasi-CD). There were significant correlations between quasi-CD sway and medial-lateral COP velocity (Pearson r = 0.65, P = 0.03), as well as between quasi-SVA sway and COP sway area (r = 0.65, P = 0.03). CONCLUSION Given the considerable fluctuation of quasi-SVA and quasi-CD during quiet standing, the reliability of radiographic measurement using CD and SVA at a specific moment can be substantially compromised. The assessment based on the currently proposed cut-off values should be interpreted with caution, and repeat examinations are warranted. LEVEL OF EVIDENCE 4.
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Lenke LG, Shaffrey CI, Carreon LY, Cheung KM, Dahl BT, Fehlings MG, Ames CP, Boachie-Adjei O, Dekutoski MB, Kebaish KM, Lewis SJ, Matsuyama Y, Mehdian H, Pellisé F, Qiu Y, Schwab FJ. Lower Extremity Motor Function Following Complex Adult Spinal Deformity Surgery: Two-Year Follow-up in the Scoli-RISK-1 Prospective, Multicenter, International Study. J Bone Joint Surg Am 2018; 100:656-665. [PMID: 29664852 PMCID: PMC5916483 DOI: 10.2106/jbjs.17.00575] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The reported neurologic complication rate following surgery for complex adult spinal deformity (ASD) is variable due to several factors. Most series have been retrospective with heterogeneous patient populations and use of nonuniform neurologic assessments. The aim of this study was to prospectively document lower extremity motor function by means of the American Spinal Injury Association (ASIA) lower extremity motor score (LEMS) before and through 2 years after surgical correction of complex ASD. METHODS The Scoli-RISK-1 study enrolled 272 patients with ASD, from 15 centers, who had undergone primary or revision surgery for a major Cobb angle of ≥80°, corrective osteotomy for congenital spinal deformity or as a revision procedure for any type of deformity, and/or a complex 3-column osteotomy. RESULTS One of 272 patients lacked preoperative data and was excluded from the analysis, and 62 (22.9%) of the remaining 271 patients, who were included, lacked a 2-year postoperative assessment. Patients with no preoperative motor impairment (normal LEMS group; n = 203) had a small but significant decline from the mean preoperative LEMS value (50) to that at 2 years postoperatively (49.66 [95% confidence interval = 49.46 to 49.85]; p = 0.002). Patients who did have a motor deficit preoperatively (n = 68; mean LEMS, 43.79) had significant LEMS improvement at 6 months (47.21, p < 0.001) and 2 years (46.12, p = 0.003) postoperatively. The overall percentage of patients (in both groups combined) who had a postoperative LEMS decline, compared with the preoperative value, was 23.0% at discharge, 17.1% at 6 weeks, 9.9% at 6 months, and 10.0% at 2 years. CONCLUSIONS The percentage of patients who had a LEMS decline (compared with the preoperative score) after undergoing complex spinal reconstructive surgery for ASD was 23.0% at discharge, which improved to 10.0% at 2 years postoperatively. These rates are higher than previously reported, which we concluded was due to the prospective, strict nature of the LEMS testing of patients with these challenging deformities. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Lawrence G. Lenke
- Columbia University Medical Center, New York, NY,E-mail address for L.G. Lenke:
| | | | | | | | - Benny T. Dahl
- Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
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Lee NJ, Kothari P, Kim JS, Shin JI, Phan K, Di Capua J, Somani S, Leven DM, Guzman JZ, Cho SK. Early Complications and Outcomes in Adult Spinal Deformity Surgery: An NSQIP Study Based on 5803 Patients. Global Spine J 2017; 7:432-440. [PMID: 28811987 PMCID: PMC5544158 DOI: 10.1177/2192568217699384] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
STUDY DESIGN Retrospective analysis. OBJECTIVE The purpose of this study is to determine the incidence, impact, and risk factors for short-term postoperative complications following elective adult spinal deformity (ASD) surgery. METHODS Current Procedural Terminology codes were used to query the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) for adults who underwent spinal deformity surgery from 2010 to 2014. Patients were separated into groups of those with and without complications. Univariate analysis and multivariate logistic regression were used to assess the impact of patient characteristics and operative features on postoperative outcomes. RESULTS In total, 5803 patients were identified as having undergone ASD surgery in the NSQIP database. The average patient age was 59.5 (±13.5) years, 59.0% were female, and 81.1% were of Caucasian race. The mean body mass index was 29.5(±6.6), with 41.9% of patients having a body mass index of 30 or higher. The most common comorbidities were hypertension requiring medication (54.5%), chronic obstructive pulmonary disease (4.9%), and bleeding disorders (1.2%). Nearly a half of the ASD patients had an operative time >4 hours. The posterior fusion approach was more common (56.9%) than an anterior one (39.6%). The mean total relative value unit was 73.4 (±28.8). Based on multivariate analyses, several patient and operative characteristics were found to be predictive of morbidity. CONCLUSION Surgical correction of ASD is associated with substantial risk of intraoperative and postoperative complications. Preoperative and intraoperative variables were associated with increased morbidity and mortality. This data may assist in developing future quality improvement activities and saving costs through measurable improvement in patient safety.
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Affiliation(s)
- Nathan J. Lee
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Parth Kothari
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jun S. Kim
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - John I. Shin
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kevin Phan
- University of New South Wales, Sydney, New South Wales, Australia,Prince of Wales Private Hospital, Sydney, New South Wales, Australia
| | - John Di Capua
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Dante M. Leven
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Samuel K. Cho
- Icahn School of Medicine at Mount Sinai, New York, NY, USA,Samuel K. Cho, Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, Box 1188, New York, NY 10029, USA.
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Kelly MP, Lenke LG, Godzik J, Pellise F, Shaffrey CI, Smith JS, Lewis SJ, Ames CP, Carreon LY, Fehlings MG, Schwab F, Shimer AL. Retrospective analysis underestimates neurological deficits in complex spinal deformity surgery: a Scoli-RISK-1 Study. J Neurosurg Spine 2017; 27:68-73. [DOI: 10.3171/2016.12.spine161068] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe authors conducted a study to compare neurological deficit rates associated with complex adult spinal deformity (ASD) surgery when recorded in retrospective and prospective studies. Retrospective studies may underreport neurological deficits due to selection, detection, and recall biases. Prospective studies are expensive and more difficult to perform, but they likely provide more accurate estimates of new neurological deficit rates.METHODSNew neurological deficits were recorded in a prospective study of complex ASD surgeries (pSR1) with a defined outcomes measure (decrement in American Spinal Injury Association lower-extremity motor score) for neurological deficits. Using identical inclusion criteria and a subset of participating surgeons, a retrospective study was created (rSR1) and neurological deficit rates were collected. Continuous variables were compared with the Student t-test, with correction for multiple comparisons. Neurological deficit rates were compared using the Mantel-Haenszel method for standardized risks. Statistical significance for the primary outcome measure was p < 0.05.RESULTSOverall, 272 patients were enrolled in pSR1 and 207 patients were enrolled in rSR1. Inclusion criteria, defining complex spinal deformities, and exclusion criteria were identical. Sagittal Cobb measurements were higher in pSR1, although sagittal alignment was similar. Preoperative neurological deficit rates were similar in the groups. Three-column osteotomies were more common in pSR1, particularly vertebral column resection. New neurological deficits were more common in pSR1 (pSR1 17.3% [95% CI 12.6–22.2] and rSR1 9.0% [95% CI 5.0–13.0]; p = 0.01). The majority of deficits in both studies were at the nerve root level, and the distribution of level of injury was similar.CONCLUSIONSNew neurological deficit rates were nearly twice as high in the prospective study than the retrospective study with identical inclusion criteria. These findings validate concerns regarding retrospective cohort studies and confirm the need for and value of carefully designed prospective, observational cohort studies in ASD.
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Affiliation(s)
- Michael P. Kelly
- 1Department of Orthopedic Surgery, Washington University, Saint Louis, Missouri
| | - Lawrence G. Lenke
- 2Department of Orthopedic Surgery, Columbia College of Physicians and Surgeons, New York, New York
| | - Jakub Godzik
- 3Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona
| | - Ferran Pellise
- 4Orthopedic Surgery and Traumatology, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Christopher I. Shaffrey
- 5Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Justin S. Smith
- 5Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Stephen J. Lewis
- 6Division of Orthopaedics, University of Toronto, Ontario, Canada
| | - Christopher P. Ames
- 7Department of Neurological Surgery, University of California, San Francisco, California
| | | | | | - Frank Schwab
- 10Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York; and
| | - Adam L. Shimer
- 11Department of Orthopedic Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
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Neurologic Deficits Have a Negative Impact on Patient-Related Outcomes in Primary Presentation Adult Symptomatic Lumbar Scoliosis Surgical Treatment at One-Year Follow-up. Spine (Phila Pa 1976) 2017; 42:479-489. [PMID: 28351071 PMCID: PMC5373095 DOI: 10.1097/brs.0000000000001800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective analysis of prospective, multicenter National Institute of Health clinical trial. OBJECTIVE The aim of this study was to assess the rate of neurologic complications and impact of new neurologic deficits on 1-year postoperative patient-reported outcomes (PROs). SUMMARY OF BACKGROUND DATA There are limited studies evaluating the impact of new neurologic deficits on PROs following surgery for primary presentation adult lumbar scoliosis. METHODS Patients were divided into two groups: new postoperative neurological deficit (Def) or no deficit (NoDef). Preoperative and 1-year follow-up PROs were analyzed [Scoliosis Research Society (SRS) Questionnaire, Oswestry Disability Index (ODI), Short Form-12 Physical/Mental Health Composite Scores (PCS/MCS), and back/leg pain Numerical Rating Scale (NRS)]. RESULTS One hundred forty-one patients: 14 Def (9.9%), 127 NoDef (90.1%). No differences were observed in demographic, radiographic, or PRO data between groups preoperatively. Def group had longer surgical procedures (8.3 vs. 6.9 hours, P = 0.030), greater blood loss (2832 vs. 2606 mL, P = 0.022), and longer hospitalizations (10.6 vs. 7.8 days, P = 0.004). NoDef group reported significant improvement in all PROs from preop to 1-year postoperative. Def group only had improvement in SRS Pain (2.7 preop to 3.4 postop, P = 0.037) and self-image domains (2.7 to 3.6, p = 0.004), and NRS back pain (6.6 to 3.2, P = 0.004) scores with significant worsening of NRS leg pain (4.1 to 6.1, P = 0.045). Group comparisons of 1-year postop PROs found that Def group reported more NRS leg pain (6.1 vs. 1.7, P < 0.001) and worse outcomes than NoDef group for ODI (35.7 vs. 23.1, P = 0.016) and PCS (32.6 vs. 41.9, P = 0.007). CONCLUSION We found a 9.9% rate of new neurologic deficits following surgery for symptomatic primary presentation adult lumbar scoliosis, much higher than previous studies. Most neurologic deficits improved by 1-year follow-up, but appeared to have a dramatic negative impact on PROs, with increased postoperative leg pain and greater patient-perceived pathology reported in patients experiencing neurological deficits compared with those who did not. LEVEL OF EVIDENCE 3.
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Rebouças FP, Sperandio EF, Alexandre AS, Yi LC, Gotfryd AO, Vidotto MC. The use of photogrammetry to evaluate chest wall after arthrodesis in patients with Adolescent Idiopathic Scoliosis. FISIOTERAPIA EM MOVIMENTO 2017. [DOI: 10.1590/1980-5918.030.s01.ao30] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Introduction: Adolescent Idiopathic Scoliosis (AIS) is a three-dimensional spine deformity that creates changes in the rib cage biomechanics. Objective: Evaluate changes on the chest wall, quality of life and lung function on the preoperative and postoperative of arthrodesis in patients with AIS. Methods: Eighteen AIS patients with surgical indication for arthrodesis of both sexes aged between 11 and 18 years were evaluated. The evaluation of the chest was taken by using photogrammetry Postural Assessment Software (PAS). Thoracic markers were created using angles (A) and distances (D): A1 (bilateral acromion/manubrium), A2 (bilateral acromion/xiphoid process), A3 (bilateral rib/xiphoid process), A5 (acromion/scapula inferior angle/inframammilary), A6 (C7/acromion/T3), A7 (scapular irregularity) and D3 (xiphoid process to the anterior superior iliac spine). Spirometry and assessment of Quality of Life Questionnaire (SRS - 30) was performed. Evaluations were performed on the preoperative period (PRE), on two months of postoperative (PO1) and on the late postoperative period (LPO). Data were analysed using analysis of variance with repeated measures and Bonferroni method comparisons. Results: The thoracic markers A1, A2, A3, A5, A6, A7 and D3 showed significant difference in the LPO. All domains and the total score of the SRS - 30 questionnaire showed significant increase in periods PO1 and LPO. The FVC and FEV1 showed significant increase in the LPO. Conclusion: After arthrodesis patients with AIS showed alterations in the chest wall, associated with improved quality of life and lung function, especially in the late postoperative period.
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Sánchez-Mariscal F, Gomez-Rice A, Rodríguez-López T, Zúñiga L, Pizones J, Núñez-García A, Izquierdo E. Preoperative and postoperative sagittal plane analysis in adult idiopathic scoliosis in patients older than 40 years of age. Spine J 2017; 17:56-61. [PMID: 27503264 DOI: 10.1016/j.spinee.2016.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 06/20/2016] [Accepted: 08/02/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Most of the papers correlate sagittal radiographic parameters with health-related quality of life (HRQOL) scores for patients with scoliosis. However, we do not know how changes in sagittal profile influence clinical outcomes after surgery in adult population operated for mainly frontal deformity. PURPOSE This study aimed to analyze spinal sagittal profile in a population operated on adult idiopathic scoliosis (AS) and to describe variations in sagittal parameters after surgery and the association between those variations and clinical outcomes. DESIGN/SETTING This is a historical cohort study. PATIENT SAMPLE We included in this study 40 patients operated on AS, older than 40 at the time of surgery (mean age 54.9), and with more than 2-year follow-up (mean 7.4 years). OUTCOME MEASURES Full-length free-standing radiographs, Scoliosis Research Society 22 (SRS22) and Short Form 36 (SF36) instruments, and satisfaction with outcomes were available at final follow-up. METHODS Sagittal preoperative and final follow-up radiographic parameters, radiographic correlation with HRQOL scores at final follow-up, and association between satisfaction and changes in sagittal profile were analyzed. A multivariate analysis was performed. No funds were received for this article. RESULTS Preoperatively, the spinal sagittal plane tended to exhibit kyphosis. Most sagittal parameters did not improve at final follow-up with respect to preoperative values. We saw, after univariate analysis, that worse sagittal profile leads to worse HRQOL, but after multivariate analysis, only spinal tilt (ST) persisted as possible predictor for worse SRS activity scores. Frontal Cobb significantly improved. Most patients (82%) were satisfied with final outcomes. Variations in sagittal profile parameters did not differ between satisfied and dissatisfied patients. CONCLUSIONS Although most sagittal plane parameters did not improve after surgery, surgical treatment in AS achieves a high satisfaction rate. Good clinical results do not correlate with improving sagittal plane parameters. Sagittal profile measurements are not helpful to decide surgical treatment in patients with mainly frontal deformity.
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Affiliation(s)
- Felisa Sánchez-Mariscal
- Spinal Unit, Hospital Universitario de Getafe, Carretera de Toledo km 12.5, Getafe, Madrid 28905, Spain.
| | - Alejandro Gomez-Rice
- Spinal Unit, Hospital Universitario de Getafe, Carretera de Toledo km 12.5, Getafe, Madrid 28905, Spain
| | - Tamara Rodríguez-López
- Spinal Unit, Hospital Universitario de Getafe, Carretera de Toledo km 12.5, Getafe, Madrid 28905, Spain
| | - Lorenzo Zúñiga
- Spinal Unit, Hospital Universitario de Getafe, Carretera de Toledo km 12.5, Getafe, Madrid 28905, Spain
| | - Javier Pizones
- Spinal Unit, Hospital Universitario de Getafe, Carretera de Toledo km 12.5, Getafe, Madrid 28905, Spain
| | - Ana Núñez-García
- Spinal Unit, Hospital Universitario de Getafe, Carretera de Toledo km 12.5, Getafe, Madrid 28905, Spain
| | - Enrique Izquierdo
- Spinal Unit, Hospital Universitario de Getafe, Carretera de Toledo km 12.5, Getafe, Madrid 28905, Spain
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Kurapati NT, Krzak JJ, Graf A, Hassani S, Tarima S, Sturm PF, Hammerberg K, Gupta P, Harris GF. Effect of Surgical Fusion on Volitional Weight-Shifting in Individuals With Adolescent Idiopathic Scoliosis. Spine Deform 2016; 4:432-438. [PMID: 27927573 DOI: 10.1016/j.jspd.2016.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 06/22/2016] [Accepted: 08/03/2016] [Indexed: 12/31/2022]
Abstract
STUDY DESIGN Prospective. OBJECTIVES The goals of this study were to (1) evaluate the differences in weightbearing symmetry between individuals with adolescent idiopathic scoliosis (AIS) and typically developing controls; (2) observe the effect of posterior spinal fusion and instrumentation (PSFI) on volitional weight-shifting at 1 and 2 years postoperatively; and (3) evaluate whether lowest instrumented fusion level (ie, lowest instrumented vertebra [LIV]) in PSFI has an effect on volitional weight-shifting. SUMMARY OF BACKGROUND DATA Previous studies have conflicting findings with regard to the effect of scoliosis on postural control tasks as well as the effect of surgery. They have also noted an inconsistent effect of PSFI at different LIVs, with more distal LIVs exhibiting greater reductions in postoperative range of motion. METHODS The study was designed with an AIS group of 41 patients (8 males and 33 females) with AIS who underwent PSFI, along with a Control Group of 24 age-matched typically developing participants (12 male and 12 female). Both groups performed postural control tasks (static balance and volitional weight-shifting), with the AIS group repeating the tasks at 1 and 2 years postoperatively. RESULTS At baseline, the AIS group showed increased weightbearing asymmetry than the Control Group (p = .01). The AIS group showed improvements in volitional weight-shifting at 2 years over baseline (p < .01). There was no effect of LIV on volitional weight-shifting by the second postoperative year. CONCLUSIONS Individuals with AIS have greater weightbearing asymmetry but improved volitional weight-shifting over typically developing controls. PSFI improves volitional weight-shifting beyond preoperative baseline but does not differ significantly by LIV.
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Affiliation(s)
- Nikhil T Kurapati
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI, USA; College of Engineering, Marquette University, Milwaukee, WI, USA; Motion Analysis Laboratory, Shriners Hospital for Children, Chicago, IL, USA.
| | - Joseph J Krzak
- Motion Analysis Laboratory, Shriners Hospital for Children, Chicago, IL, USA; Physical Therapy Program, College of Health Sciences, Midwestern University, Downers Grove, IL, USA
| | - Adam Graf
- Motion Analysis Laboratory, Shriners Hospital for Children, Chicago, IL, USA
| | - Sahar Hassani
- Motion Analysis Laboratory, Shriners Hospital for Children, Chicago, IL, USA
| | - Sergey Tarima
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Peter F Sturm
- Motion Analysis Laboratory, Shriners Hospital for Children, Chicago, IL, USA; Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kim Hammerberg
- Motion Analysis Laboratory, Shriners Hospital for Children, Chicago, IL, USA
| | - Purnendu Gupta
- Motion Analysis Laboratory, Shriners Hospital for Children, Chicago, IL, USA
| | - Gerald F Harris
- College of Engineering, Marquette University, Milwaukee, WI, USA; Motion Analysis Laboratory, Shriners Hospital for Children, Chicago, IL, USA
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Hawasli AH, Chang J, Yarbrough CK, Steger-May K, Lenke LG, Dorward IG. Interpedicular height as a predictor of radicular pain in adult degenerative scoliosis. Spine J 2016; 16:1070-8. [PMID: 27151385 PMCID: PMC5533167 DOI: 10.1016/j.spinee.2016.04.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 04/12/2016] [Accepted: 04/27/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Spine surgeons must correlate clinical presentation with radiographic findings in a patient-tailored approach. Despite the prevalence of adult degenerative scoliosis (ADS), there are few radiographic markers to predict the presence of radiculopathy. Emerging data suggest that spondylolisthesis, obliquity, foraminal stenosis, and curve concavity may be associated with radiculopathy in ADS. PURPOSE The purpose of this study was to determine if radicular pain in ADS is associated with reduced interpedicular heights (IPHs) as measured on routine radiographs. STUDY DESIGN/SETTING This is a retrospective case-controlled study. PATIENT SAMPLE The authors carried out a retrospective chart review at a tertiary care referral center that included ADS patients referred to scoliosis surgeons between 2012 and 2014. Inclusion criteria included patients with ADS and no prior thoracolumbar surgery. Data were collected from initial spine surgeon clinic notes and radiographs. OUTCOME MEASURES Clinical outcome data included presence, side(s), and level(s) of radicular pain; presence of motor deficits; and presence of sensory deficits. METHODS Variables included age, gender, Scoliosis Research Society-30 (SRS-30) and Oswestry Disability Index (ODI) questionnaire data, and radiographic measurements. Radiographic measurements included Cobb angles and L1 to S1 IPHs on upright and supine radiographs. Associations between variables and outcome measures were assessed with univariate and multivariate statistical analyses. Authors have no conflicts of interests relevant to this study. RESULTS A total of 200 patients with an average age of 51 years met the inclusion criteria. Sixty of the 200 patients presented with radicular pain. Older age was associated with radicular pain, weakness, and sensory deficits. Patients who were 55 years or older were approximately eight times more likely to have radicular pain (odds ratio [OR]=7.96, 95% confidence interval [CI]: 3.73, 17.0; p<.001), five times more likely to have motor deficit (OR=5, 95% CI: 2.55, 9.79; p<.001), and five times more likely to have sensory deficit (OR=5.2, 95% CI: 2.65, 10.2; p<.001) than those younger than 55. More caudally located nerve roots are more likely to develop radicular pain (p<.001). Motor deficits were associated with worse SRS-30 functional (p=.02) and ODI scores (p=.005), but radicular pain and sensory deficits were not associated with lower SRS-30 or ODI scores. Ipsilateral and same-level radicular pain were associated with reduced IPH on supine radiographs (p=.002 and p=.0002, respectively). Finally, reduced IPH on upright radiographs was associated with side- and level-specific radicular pain (p=.04). CONCLUSIONS Radicular pain in ADS patients is associated with reduced IPHs and older age. Measuring IPHs on routine radiographs may be helpful in associating clinical radiculopathy with radiographic measures to guide patient management and surgical planning.
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Affiliation(s)
- Ammar H. Hawasli
- Department of Neurosurgery, Washington University School of
Medicine, St. Louis, MO
| | - Jodie Chang
- Department of Neurosurgery, Washington University School of
Medicine, St. Louis, MO
| | - Chester K. Yarbrough
- Department of Neurosurgery, Washington University School of
Medicine, St. Louis, MO
| | - Karen Steger-May
- Division of Biostatistics, Washington University School of Medicine,
St. Louis, MO
| | - Lawrence G. Lenke
- Department of Orthopaedic Surgery, Washington University School of
Medicine, St. Louis, MO
| | - Ian G. Dorward
- Department of Neurosurgery, Washington University School of
Medicine, St. Louis, MO,Department of Orthopaedic Surgery, Washington University School of
Medicine, St. Louis, MO
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Verla T, Adogwa O, Toche U, Farber SH, Petraglia F, Murphy KR, Thomas S, Fatemi P, Gottfried O, Bagley CA, Lad SP. Impact of Increasing Age on Outcomes of Spinal Fusion in Adult Idiopathic Scoliosis. World Neurosurg 2015; 87:591-7. [PMID: 26546999 DOI: 10.1016/j.wneu.2015.10.061] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 10/11/2015] [Accepted: 10/12/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To investigate the role of advancing age on postoperative complications and revision surgery after fusion for scoliosis. METHODS A retrospective, cohort study was performed using the Thomson Reuters MarketScan database, examining patients with adult scoliosis who underwent spinal fusion from 2000 to 2009. Primary outcomes included infection, hemorrhage and pulmonary embolism (PE) within 90 days of surgery, and refusion. The effect of increasing age was estimated using the odds ratio (OR) of complications in a multivariate logistic regression analysis, and a Cox proportional hazard model estimated the hazard ratio of refusion. RESULTS A total of 8432 patients were included in this study. Overall, the average age was 53.3 years, with 26.90% males and 39% with a Charlson Comorbidity Score of ≥ 1. Most patients had commercial insurance (66.81%), with 26.03% and 7.16% covered by Medicare and Medicaid, respectively. Increasing age (per 5-year increment) was a significant predictor of hemorrhagic complication (OR, 1.06; confidence interval [CI], 1.01-1.11; P = 0.0196), PE (OR, 1.09; CI, 1.03-1.16; P = 0.0031), infection (OR, 1.04; CI, 1.01-1.07; P = 0.0053), and refusion (hazard ratio, 1.07; CI, 1.02-1.13; P = 0.0103). CONCLUSIONS In this study, age was associated with increased risk of hemorrhage, PE, infection, and refusion. With the aging population, the role of patient age on postoperative healing and outcomes deserves deeper investigation after repair of adult idiopathic scoliosis.
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Affiliation(s)
- Terence Verla
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Owoicho Adogwa
- Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Ulysses Toche
- Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Frank Petraglia
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Kelly R Murphy
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Steven Thomas
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Parastou Fatemi
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Oren Gottfried
- Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Carlos A Bagley
- Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Shivanand P Lad
- Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.
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15
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Sciubba DM, Yurter A, Smith JS, Kelly MP, Scheer JK, Goodwin CR, Lafage V, Hart RA, Bess S, Kebaish K, Schwab F, Shaffrey CI, Ames CP. A Comprehensive Review of Complication Rates After Surgery for Adult Deformity: A Reference for Informed Consent. Spine Deform 2015; 3:575-594. [PMID: 27927561 DOI: 10.1016/j.jspd.2015.04.005] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 04/09/2015] [Accepted: 04/09/2015] [Indexed: 01/23/2023]
Abstract
OBJECTIVE An up-to-date review of recent literatures and a comprehensive reference for informed consent specific to ASD complications is lacking. The goal of the present study was to determine current complication rates after ASD surgery, in order to provide a reference for informed consent as well as to determine differences between three-column and non-three-column osteotomy procedures to aid in shared decision making. METHODS A review of the literature was conducted using the PubMed database. Randomized controlled trials, nonrandomized trials, cohort studies, case-control studies, and case series providing postoperative complications published in 2000 or later were included. Complication rates were recorded and calculated for perioperative (both major and minor) and long-term complication rates. Postoperative outcomes were all stratified by surgical procedure (ie, three-column osteotomy and non-three-column osteotomy). RESULTS Ninety-three articles were ultimately eligible for analysis. The data of 11,692 patients were extracted; there were 3,646 complications, mean age at surgery was 53.3 years (range: 25-77 years), mean follow-up was 3.49 years (range: 6 weeks-9.7 years), estimated blood loss was 2,161 mL (range: 717-7,034 mL), and the overall mean complication rate was 55%. Specifically, major perioperative complications occurred at a mean rate of 18.5%, minor perioperative complications occurred at a mean rate of 15.7%, and long-term complications occurred at a mean rate of 20.5%. Furthermore, three-column osteotomy resulted in a higher overall complication rate and estimated blood loss than non-three-column osteotomy. CONCLUSIONS A review of recent literatures providing complication rates for ASD surgery was performed, providing the most up-to-date incidence of early and late complications. Providers may use such data in helping to counsel patients of the literature-supported complication rates of such procedures despite the planned benefits, thus obtaining a more thorough informed consent.
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Affiliation(s)
- Daniel M Sciubba
- Department of Neurosurgery, The Johns Hopkins Hospital, 600 North Wolfe Street; Meyer Building, Room 7-109, Baltimore, MD 21287, USA.
| | - Alp Yurter
- Department of Neurosurgery, The Johns Hopkins Hospital, 600 North Wolfe Street; Meyer Building, Room 7-109, Baltimore, MD 21287, USA
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia Health System, 1215 Lee St, Charlottesville, VA 22903, USA
| | - Michael P Kelly
- Department of Orthopedic Surgery, Washington University, 4921 Parkview Place, A 12, St. Louis, MO 63110, USA
| | - Justin K Scheer
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Suite 2210, Chicago, IL 60611, USA
| | - C Rory Goodwin
- Department of Neurosurgery, The Johns Hopkins Hospital, 600 North Wolfe Street; Meyer Building, Room 7-109, Baltimore, MD 21287, USA
| | - Virginie Lafage
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 306 E 15th Street, Suite 1F, New York, NY 10003, USA
| | - Robert A Hart
- Department of Orthopaedic Surgery, Oregon Health & Science University, 3182 SW Sam Jackson Park Rd; Ortho Dept MC: OP31, Portland, OR 97239, USA
| | - Shay Bess
- Rocky Mountain Hospital for Children, 2055 High Street, Suite 130, Denver, CO 80205, USA
| | - Khaled Kebaish
- Department of Orthopaedic Surgery, Johns Hopkins University, 610 North Caroline Street, Suite 5243, Baltimore, MD 21287, USA
| | - Frank Schwab
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 306 E 15th Street, Suite 1F, New York, NY 10003, USA
| | - Christopher I Shaffrey
- Department of Neurosurgery, University of Virginia Health System, 1215 Lee St, Charlottesville, VA 22903, USA
| | - Christopher P Ames
- Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Ave, M779 - Department of Neurosurgery, San Francisco, CA 94143, USA
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Yoshihara H. Pain medication use after spine surgery: is it assessed in the literature? A systematic review, January 2000-December 2009. BMC Res Notes 2015. [PMID: 26219552 PMCID: PMC4518636 DOI: 10.1186/s13104-015-1287-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Spine surgery is one of the most difficult areas in which to achieve a good clinical outcome and pain medication is often used for a long period of time after surgery. The purpose of this study was to investigate whether pain medication use after spine surgery has been assessed previously with respect to clinical outcome. Methods A systematic review of PubMed/MEDLINE databases was conducted from Jan 1st 2000 to Dec 31st 2009 using the search key words, “spine surgery” and “clinical outcome.” All publications reporting clinical outcomes were examined and analyzed for outcome measures and data with respect to pain medication use after spine surgery. Results In total 990 articles met the inclusion criteria. Among them, 56 articles (5.7%) described definitive pain medication use after spine surgery; 98 articles (9.9%) used clinical outcome measures that incorporate pain medication assessment, although only one such study included a definitive description of pain medication use. Conclusions Pain medication use after spine surgery was assessed in 15.5% of articles published during the last decade. The use of pain medication following spine surgery can affect clinical outcome and, therefore, needs to be taken into consideration for clinical assessment. In future studies, a detailed description of pain medication use and/or clinical outcome measures that incorporate pain medication assessment are advocated when reporting clinical outcomes after spine surgery so that it can be better assessed. Electronic supplementary material The online version of this article (doi:10.1186/s13104-015-1287-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hiroyuki Yoshihara
- Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, 450 Clarkson Ave, Brooklyn, NY, 11203, USA. .,Department of Orthopaedic Surgery, Nassau University Medical Center, East Meadow, NY, USA. .,Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan.
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Dangelmajer S, Zadnik PL, Rodriguez ST, Gokaslan ZL, Sciubba DM. Minimally invasive spine surgery for adult degenerative lumbar scoliosis. Neurosurg Focus 2015; 36:E7. [PMID: 24785489 DOI: 10.3171/2014.3.focus144] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Historically, adult degenerative lumbar scoliosis (DLS) has been treated with multilevel decompression and instrumented fusion to reduce neural compression and stabilize the spinal column. However, due to the profound morbidity associated with complex multilevel surgery, particularly in elderly patients and those with multiple medical comorbidities, minimally invasive surgical approaches have been proposed. The goal of this meta-analysis was to review the differences in patient selection for minimally invasive surgical versus open surgical procedures for adult DLS, and to compare the postoperative outcomes following minimally invasive surgery (MIS) and open surgery. METHODS In this meta-analysis the authors analyzed the complication rates and the clinical outcomes for patients with adult DLS undergoing complex decompressive procedures with fusion versus minimally invasive surgical approaches. Minimally invasive surgical approaches included decompressive laminectomy, microscopic decompression, lateral and extreme lateral interbody fusion (XLIF), and percutaneous pedicle screw placement for fusion. Mean patient age, complication rates, reoperation rates, Cobb angle, and measures of sagittal balance were investigated and compared between groups. RESULTS Twelve studies were identified for comparison in the MIS group, with 8 studies describing the lateral interbody fusion or XLIF and 4 studies describing decompression without fusion. In the decompression MIS group, the mean preoperative Cobb angle was 16.7° and mean postoperative Cobb angle was 18°. In the XLIF group, mean pre- and postoperative Cobb angles were 22.3° and 9.2°, respectively. The difference in postoperative Cobb angle was statistically significant between groups on 1-way ANOVA (p = 0.014). Mean preoperative Cobb angle, mean patient age, and complication rate did not differ between the XLIF and decompression groups. Thirty-five studies were identified for inclusion in the open surgery group, with 18 studies describing patients with open fusion without osteotomy and 17 papers detailing outcomes after open fusion with osteotomy. Mean preoperative curve in the open fusion without osteotomy and with osteotomy groups was 41.3° and 32°, respectively. Mean reoperation rate was significantly higher in the osteotomy group (p = 0.008). On 1-way ANOVA comparing all groups, there was a statistically significant difference in mean age (p = 0.004) and mean preoperative curve (p = 0.002). There was no statistically significant difference in complication rates between groups (p = 0.28). CONCLUSIONS The results of this study suggest that surgeons are offering patients open surgery or MIS depending on their age and the severity of their deformity. Greater sagittal and coronal correction was noted in the XLIF versus decompression only MIS groups. Larger Cobb angles, greater sagittal imbalance, and higher reoperation rates were found in studies reporting the use of open fusion with osteotomy. Although complication rates did not significantly differ between groups, these data are difficult to interpret given the heterogeneity in reporting complications between studies.
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Affiliation(s)
- Sean Dangelmajer
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland; and
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19
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Survivorship analysis after primary fusion for adult scoliosis. Prognostic factors for reoperation. Spine J 2014; 14:1629-34. [PMID: 24345472 DOI: 10.1016/j.spinee.2013.09.050] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Revised: 07/09/2013] [Accepted: 09/27/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Adult scoliosis surgery is a challenging procedure with high rate of complications and reoperations. Reoperation rates vary widely. Long-term survival for this surgery still remains unknown, and the prognostic factors for reoperation are not well defined. PURPOSE To assess adult scoliosis surgery survival (without the need of reoperation) after primary fusion in adults with mainly frontal deformity and to define prognostic factors for reoperation. STUDY DESIGN Survival analysis of a cohort of consecutive adult patients, primarily operated on scoliosis using segmental instrumentation (retrospective cohort study). PATIENT SAMPLE Fifty-nine patients older than 21 years at primary surgery (median age, 42 years), who presented idiopathic or degenerative curves with frontal Cobb >40° (median preoperative frontal Cobb 59°), more than four-level fusion, and a 2-year minimum postoperative follow-up (median, 8.5 years; 41% patients had a longer than 10-year follow-up). OUTCOME MEASURES Clinical and preoperative radiographic parameters were analyzed preoperatively and evaluated as prognostic factors for reoperation. METHODS Survival was estimated using Kaplan-Meier method. Prognostic factors (clinical and radiographic) for reoperation were evaluated. Logistic regression using backward elimination was used for multivariate analysis. RESULTS Survival was 89.8% at 1 year, 79.4% at 2 years, 73.4% at 3 years, 64% at 5 years, and 60.9% at 10 years. Overall, 21 patients (35.6%) underwent revision surgery. The most common reasons for reoperation were painful/prominent implants, adjacent-segment degeneration, and infection. American Society of Anesthesiologists Type II patients and double surgical approach were associated with a higher revision rate. Preoperative thoracic kyphosis was significantly higher in reoperated patients. CONCLUSIONS The 10-year survival rate of primary scoliosis surgery in adult patients is 61%. Risk factors identified for reoperation included patients with higher morbidity, double surgical approach, and preoperative thoracic hyperkyphosis.
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Udoekwere UI, Krzak JJ, Graf A, Hassani S, Tarima S, Riordan M, Sturm PF, Hammerberg KW, Gupta P, Anissipour AK, Harris GF. Effect of Lowest Instrumented Vertebra on Trunk Mobility in Patients With Adolescent Idiopathic Scoliosis Undergoing a Posterior Spinal Fusion. Spine Deform 2014; 2:291-300. [PMID: 27927350 DOI: 10.1016/j.jspd.2014.04.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 04/03/2014] [Accepted: 04/06/2014] [Indexed: 12/20/2022]
Abstract
STUDY DESIGN Prospective. OBJECTIVES The goal of this study was to evaluate the effect of posterior spinal fusion surgery terminating at different lowest instrumented vertebrae (LIV) on trunk mobility in individuals with adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA Posterior spinal fusion with instrumentation is the standard surgical technique employed in AIS for correcting spine deformities with Cobb angles exceeding 50°. Surgical correction of curve deformity reduces trunk mobility and range of motion. However, conflicting findings from previous studies investigating the impact of different LIV levels on the reduction in trunk mobility after surgery have been reported. METHODS The study was designed as a prospective study with 47 patients (7 males and 40 females) with AIS who underwent posterior spinal fusion. Patients were classified into 5 groups based on their surgical LIV level (ie, T12, L1, L2, L3, and L4). Trunk flexion-extension (sagittal plane), lateral bending (coronal plane), and axial rotation (transverse plane) kinematics were assessed during preoperative, 1 year postoperative, and 2 years postoperative evaluation visits. RESULTS There were postoperative reductions of 41%, 51%, and 59% in trunk range of motion in the sagittal, coronal, and transverse planes, respectively (p < .0001). A trend toward greater postoperative reductions in peak forward flexion at more distal LIVs was observed (p = .04). CONCLUSIONS Fusion reduces trunk mobility in the sagittal, coronal, and transverse planes. More distal LIV fusions limit peak forward flexion to a greater extent which is considered clinically significant. After fusion, the reductions seen in axial rotation, lateral bending, and backward extension do not differ significantly at more distal LIVs.
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Affiliation(s)
| | - Joseph J Krzak
- Motion Analysis Laboratory, Shriners Hospitals for Children, Chicago, IL, USA; College of Health Sciences, Physical Therapy Program, Midwestern University, Downers Grove, IL, USA
| | - Adam Graf
- Motion Analysis Laboratory, Shriners Hospitals for Children, Chicago, IL, USA.
| | - Sahar Hassani
- Motion Analysis Laboratory, Shriners Hospitals for Children, Chicago, IL, USA
| | - Sergey Tarima
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mary Riordan
- Motion Analysis Laboratory, Shriners Hospitals for Children, Chicago, IL, USA
| | - Peter F Sturm
- Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kim W Hammerberg
- Motion Analysis Laboratory, Shriners Hospitals for Children, Chicago, IL, USA
| | - Purnendu Gupta
- Motion Analysis Laboratory, Shriners Hospitals for Children, Chicago, IL, USA
| | | | - Gerald F Harris
- College of Engineering, Marquette University, Milwaukee, WI, USA; Motion Analysis Laboratory, Shriners Hospitals for Children, Chicago, IL, USA; Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
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Percutaneous vertebroplasty in adult degenerative scoliosis for spine support: study for pain evaluation and mobility improvement. BIOMED RESEARCH INTERNATIONAL 2013; 2013:626502. [PMID: 24260742 PMCID: PMC3821888 DOI: 10.1155/2013/626502] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 08/13/2013] [Accepted: 09/10/2013] [Indexed: 11/29/2022]
Abstract
We evaluate the efficacy-safety of percutaneous vertebroplasty (PV) as primary treatment in adult degenerative scoliosis. During the last 4 years, PV was performed in 18 adult patients (68 vertebral bodies) with back pain due to degenerative scoliotic spine. Under anaesthesia and fluoroscopy, direct access to most deformed vertebral bodies was obtained by 13G needles, and PMMA for vertebroplasty was injected. Scoliosis' inner arch was supported. Clinical evaluation included immediate and delayed studies of patient's general condition and neurological status. An NVS scale helped assessing pain relief, life quality, and mobility improvement. Comparing patients' scores prior to (mean value 8.06 ± 1.3 NVS units), the morning after (mean value 3.11 ± 1.2 NVS units), at 12 (mean value 1.67 ± 1.5 NVS units), and 24 months after vertebroplasty (mean value 1.67 ± 1.5 NVS units) treatment, patients presented a mean decrease of 6.39 ± 1.6 NVS units on terms of life quality improvement and pain relief (P = 0.000). Overall mobility improved in 18/18 (100%) patients. No complications were observed. During follow-up period (mean value 17.66 months), all patients underwent a mean of 1.3 sessions for facet joint and nerve root infiltrations. Percutaneous vertebroplasty in the inner arch seems to be an effective technique for supporting adult degenerative scoliotic spine.
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Gómez-Rice A, Núñez-García A, Sánchez-Mariscal F, Álvarez-González P, Zúñiga-Gómez L, Pizones-Arce J, Sanz-Barbero E, Izquierdo-Núñez E. [Relationship between clinical results and sagittal profile in adult scoliosis. Value of the spinal-sacral angle and the spinal inclination angle]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2013; 56:426-31. [PMID: 23594939 DOI: 10.1016/j.recot.2012.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2012] [Accepted: 07/08/2012] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To assess the clinical validity of two new recently described parameters (spinal-sacral angle (SSA) and spinal inclination angle (SIA) in adult scoliosis (AS) for evaluating the spinal-pelvic sagittal profile, as well as their still undefined role in AS. MATERIAL AND METHOD A non-concurrent prospective radiographic and clinical study was conducted on 59 primary surgeries of AS (Cobb>40°), with a minimum of 2 years follow-up. The available X-rays and health questionnaires of 49 patients were used in the study. The changes in X-ray parameters after surgery were evaluated (Wilcoxon test), as well as the correlations as regards the clinical-radiography-age parameters (Spearman test and multiple linear regression). RESULTS The median post-surgical follow-up was 8.5 years, and the median age of the patients was 49.5 years. There was a statistically significant change with the surgery in the SSA and SIA (less than 5° in both), thoracic kyphosis, lumbar lordosis (LL), pelvic rotation, sagittal balance (SB) and frontal Cobb. There was no correlation between pain and SSA-ST. There was a significant relationship between activity and SSA, ST, LL, SB, and age. After the multivariate analysis only age (not SSA or SIA) remained as a possible predictor of lower activity. DISCUSSION When frontal deformity predominates, the sagittal radiographic parameters, including the newest angles, although they have an influence patient activity when analysed individually, they lose this influence when they are analysed together and with other clinical parameters. CONCLUSIONS The SSA and SIA hardly change with surgery. They only correlate with activity, but cannot be considered predictors of this. Thus they do seem to be useful measurements in AS.
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Affiliation(s)
- A Gómez-Rice
- Unidad de Raquis, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Getafe, Madrid, España
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Gómez-Rice A, Núñez-García A, Sánchez-Mariscal F, Álvarez-González P, Zúñiga-Gómez L, Pizones-Arce J, Sanz-Barbero E, Izquierdo-Núñez E. Relationship between clinical results and sagittal profile in adult scoliosis. Value of the spinal-sacral angle and the spinal inclination angle. Rev Esp Cir Ortop Traumatol (Engl Ed) 2012. [DOI: 10.1016/j.recote.2012.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Fazal A, Lakdawala RH. Fourth-generation spinal instrumentation: experience with adolescent idiopathic scoliosis at a tertiary care hospital in Pakistan. Int J Gen Med 2012; 5:151-5. [PMID: 22393301 PMCID: PMC3292398 DOI: 10.2147/ijgm.s29236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective To evaluate the radiological and functional outcome of surgical treatment of adolescent idiopathic scoliosis using fourth-generation posterior spinal instrumentation at The Aga Khan University, Karachi, Pakistan. Design Case series. Place and duration of study The Aga Khan University Hospital after a minimum of 2 years postoperatively. Patients and methods A total of 20 patients with adolescent idiopathic scoliosis were recruited into the study and evaluated for radiological and functional outcome. The study period was from 2000 to 2005. Radiological outcome was assessed using Cobb angle measurement pre and postoperatively, hence assessing percentage correction. The lower instrumented vertebra was taken as the neutral vertebra and the level was recorded. Functional outcome was determined using the Scoliosis Research Society patient administered questionnaire. All patients were called to the clinic and asked to fill in the form. Those patients who were out of the city were mailed the forms and requested via telephone to complete and return. Results Of the 20 patients operated on, twelve were female and eight were male. The average age at operation was 12.7 years. The mean Cobb angle was 69° preoperatively and 20° postoperatively, representing a percentage correction of 71%. The average duration of follow-up was 3.6 years. There was one major complication involving neurological injury post-op and two minor complications involving wound infection. The average Scoliosis Research Society score (on a scale of 1–5, with 5 being best) for pain was 4.5, self-image was 4.2, functional status was 4.1, mental status was 3.8, and satisfaction was 4.4. There was no relationship between the percentage correction of scoliosis and the functional outcome. Those patients with a high preoperative Cobb angle tended to have a better outcome for functional and mental status postoperatively. There was no relation between the lower instrumented vertebra and functional outcome. Conclusion In the correct indications, fourth-generation posterior instrumentation and fusion is a reliable and satisfactory technique to treat adolescent idiopathic scoliosis.
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Affiliation(s)
- Akil Fazal
- Hospital for Joint Disease, New York University, New York, USA
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25
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Scheufler KM, Cyron D, Dohmen H, Eckardt A. Less invasive surgical correction of adult degenerative scoliosis. Part II: Complications and clinical outcome. Neurosurgery 2011; 67:1609-21; discussion 1621. [PMID: 21107191 DOI: 10.1227/neu.0b013e3181f918cf] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Surgical correction of adult degenerative scoliosis is a technically demanding procedure with a considerable complication rate. Extensive blood loss has been identified as a significant factor linked to unfavorable outcome. OBJECTIVE To report on the complication profile and clinical outcomes obtained with less invasive image-guided surgical correction of degenerative (de novo) scoliosis in a high-risk population. METHODS Thirty patients (age, 64-88 years) with progressive postural impairment, back pain, radiculopathy, and neurogenic claudication caused by degenerative scoliosis were treated by less invasive image-guided correction (3-8 segments) by multisegmental transforaminal lumbar interbody fusion and facet fusions. With a mean follow-up of 19.6 months, intraoperative blood loss, curve correction, fusion and complication rates, duration of hospitalization, incidence of hardware-related problems, and clinical outcome parameters were assessed using multivariate analysis. RESULTS Satisfactory multiplanar correction was obtained in all patients. Mean intraoperative blood loss was 771.7±231.9 mL, time to full ambulation was 0.8±0.6 days, and length of stay was 8.2±2.9 days. After 12 months, preoperative SF12v2 physical component summary scores (20.2±2.6), visual analog scale scores (7.5±0.8), and Oswestry disability index (57.2±6.9) improved to 34.6±3.9, 2.63±0.6, and 24.8±7.1, respectively. The rate of major and minor complications was 23.4% and 59.9%, respectively. Ninety percent of patients rated treatment success as excellent, good, or fair. CONCLUSION Less invasive image-guided correction of degenerative scoliosis in elderly patients with significant comorbidity yields a favorable complication profile. Significant improvements in spinal balance, pain, and functional scores mirrored expedited ambulation and early resumption of daily activities. Less invasive techniques appear suitable to reduce periprocedural morbidity, especially in elderly patients and individuals with significant medical risk factors.
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Gotfryd AO, Franzin FJ, Raucci G, Carneiro Neto NJ, Poletto PR. Tratamento cirúrgico da escoliose idiopática do adolescente utilizando parafusos pediculares: análise dos resultados clínicos e radiográficos. COLUNA/COLUMNA 2011. [DOI: 10.1590/s1808-18512011000200002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Realizar avaliação clínica e radiográfica de pacientes com escoliose idiopática do adolescente (EIA) submetidos à artrodese por via posterior utilizando parafusos pediculares e correlacionar os resultados por imagem com os escores obtidos através do questionário SRS-24. MÉTODOS: Foram avaliados 25 pacientes com diagnóstico de escoliose idiopática do adolescente, submetidos à artrodese da coluna por via posterior com parafusos pediculares. O seguimento médio foi de 23,7 meses, variando entre 12 e 35. Analisamos critérios radiográficos referentes à correção das deformidades e aplicamos o questionário SRS-24, específico para esta doença, padronizado pela Scoliosis Research Society. RESULTADOS: A amostra foi composta por 92% de pacientes do gênero feminino e a média de idade foi de 14,2 anos. A média do índice de Cobb na radiografia ântero-posterior pré-operatória foi de 24,4° para curva torácica proximal, 54,9° para torácica principal e 38,5° para curva lombar. Os valores angulares médios no pós-operatório foram 11,0°; 16,7° e 12,2° respectivamente, com porcentagem de correção média da curva torácica principal de 69,9%. O valor médio final do questionário SRS-24 foi 98,1 pontos. Dois pacientes apresentaram complicações pós-operatórias, entretanto, nenhuma do tipo neurológica. CONCLUSÃO: A técnica se mostrou eficaz para tratamento cirúrgico da EIA, proporcionando alto percentual de correção das deformidades, com baixo risco de complicações e resultado clínico satisfatório. Não foi encontrada relação estatisticamente significante entre a porcentagem de correção da curva (torácica principal ou lombar) ou seu valor angular pós-operatório com o valor final do questionário SRS-24 nem com os domínios "satisfação" e "auto-imagem pós-operatória".
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Scheufler KM, Cyron D, Dohmen H, Eckardt A. Less Invasive Surgical Correction of Adult Degenerative Scoliosis, Part I. Neurosurgery 2010; 67:696-710. [DOI: 10.1227/01.neu.0000377851.75513.fe] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND
Adult scoliosis is a condition with increasing prevalence and medical and socioeconomic importance. Surgery is fraught with a significant complication rate in an elderly multimorbid patient population.
OBJECTIVE
To assess technical feasibility and radiographic results of image-guided less invasive correction of adult degenerative scoliosis.
METHODS
Thirty individuals (age, 64–88 years) with progressive deformity (coronal Cobb angles > 25° and < 85°), intractable back pain, radiculopathy, or neurogenic claudication were treated by less invasive decompression and fusion (unilateral transforaminal interbody cage instrumentation and bilateral facet fusions) with recombinant human bone morphogenetic protein-2, spanning 3 to 8 segments (average, 6 segments), using biplanar fluoroscopy or intraoperative computed tomography (iCT)—based navigation. Accuracy of screw placement, curve correction, and fusion rate were evaluated during a mean follow-up of 19.6 months.
RESULTS
With 415 screws implanted, misplacement (grade II or greater) was not observed, and no implants required revision. Spinal iCT with automated registration required 17.5 ± 8.5 minutes (single registration for all segments); monosegmental bilateral screw insertion required 6.8 ± 3.4 minutes. Mean sagittal (coronal) Cobb angle correction was 44.8 ± 10.7° (31.7 ± 13.7°). Mean lumbar lordosis increased from 8.8 ± 8.9° to −36 ± 6.9°, and sagittal balance was reduced from 31.6 ± 15.2 to 8 ± 8.4 mm. Solid fusion was confirmed in 90% of instrumented segments at 16 months. Average radiation dose to the surgeon was 0.025 mSv for single-level transforaminal lumbar interbody fusion with fluoroscopic guidance vs 0 mSv with iCT navigation.
CONCLUSION
Instrumented correction of adult deformity was significantly facilitated by iCT navigation, eliminating radiation exposure to the surgeon. Intraoperative biplanar CT scout views including pelvis and shoulders allow comprehensive assessment of multiplanar deformity correction. Fusion rates obtained with less invasive access equal those of conventional open technique.
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Affiliation(s)
- Kai-Michael Scheufler
- University Department of Neurosurgery, University Hospital Giessen (UKGM), Giessen, Germany
| | - Donatus Cyron
- Department of Neurosurgery, Klinikum Karlsruhe, Karlsruhe, Germany
| | - Hildegard Dohmen
- Department of Neuropathology, University Hospital Zurich, Zurich, Switzerland
| | - Anke Eckardt
- Department of Neurosurgery, Klinikum Karlsruhe, Karlsruhe, Germany
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Aebi M. Correction and stabilization of a double major adult idiopathic scoliosis from T5/L5. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2010; 19:510-2. [PMID: 20238437 DOI: 10.1007/s00586-010-1349-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Yadla S, Maltenfort MG, Ratliff JK, Harrop JS. Adult scoliosis surgery outcomes: a systematic review. Neurosurg Focus 2010; 28:E3. [PMID: 20192664 DOI: 10.3171/2009.12.focus09254] [Citation(s) in RCA: 199] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Appreciation of the optimal management of skeletally mature patients with spinal deformities requires understanding of the natural history of the disease relative to expected outcomes of surgical intervention. Appropriate outcome measures are necessary to define the surgical treatment. Unfortunately, the literature lacks prospective randomized data. The majority of published series report outcomes of a particular surgical approach, procedure, or surgeon. The purpose of the current study was to systematically review the present spine deformity literature and assess the available data on clinical and radiographic outcome measurements. METHODS A systematic review of MEDLINE and PubMed databases was performed to identify articles published from 1950 to the present using the following key words: "adult scoliosis surgery," "adult spine deformity surgery," "outcomes," and "complications." Exclusion criteria included follow-up shorter than 2 years and mean patient age younger than 18 years. Data on major curve (coronal scoliosis or lumbar lordosis Cobb angle as reported), major curve correction, Oswestry Disability Index (ODI) scores, Scoliosis Research Society (SRS) instrument scores, complications, and pseudarthroses were recorded. RESULTS Forty-nine articles were obtained and included in this review; 3299 patient data points were analyzed. The mean age was 47.7 years, and the mean follow-up period was 3.6 years. The average major curve correction was 26.6 degrees (for 2188 patients); for 2129 patients, it was possible to calculate average curve reduction as a percentage (40.7%). The mean total ODI was 41.2 (for 1289 patients), and the mean postoperative reduction in ODI was 15.7 (for 911 patients). The mean SRS-30 equivalent score was 97.1 (for 1700 patients) with a mean postoperative decrease of 23.1 (for 999 patients). There were 897 reported complications for 2175 patients (41.2%) and 319 pseudarthroses for 2469 patients (12.9%). CONCLUSIONS Surgery for adult scoliosis is associated with improvement in radiographic and clinical outcomes at a minimum 2-year follow-up. Perioperative morbidity includes an approximately 13% risk of pseudarthrosis and a greater than 40% incidence of perioperative adverse events. Incidence of perioperative complications is substantial and must be considered when deciding optimal disease management. Although the quality of published studies in this area has improved, particularly in the last few years, the current review highlights the lack of routine use of standardized outcomes measures and assessment in the adult scoliosis literature.
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Affiliation(s)
- Sanjay Yadla
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
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30
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Anand N, Rosemann R, Khalsa B, Baron EM. Mid-term to long-term clinical and functional outcomes of minimally invasive correction and fusion for adults with scoliosis. Neurosurg Focus 2010; 28:E6. [DOI: 10.3171/2010.1.focus09272] [Citation(s) in RCA: 186] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The goal of this study was to assess the operative outcomes of adult patients with scoliosis who were treated surgically with minimally invasive correction and fusion.
Methods
This was a retrospective study of 28 consecutive patients who underwent minimally invasive correction and fusion over 3 or more levels for adult scoliosis. Hospital and office charts were reviewed for clinical data. Functional outcome data were collected at each visit and at the last follow-up through self-administered questionnaires. All radiological measurements were obtained using standardized computer measuring tools.
Results
The mean age of the patients in the study was 67.7 years (range 22–81 years), with a mean follow-up time of 22 months (range 13–37 months). Estimated blood loss for anterior procedures (transpsoas discectomy and interbody fusions) was 241 ml (range 20–2000 ml). Estimated blood loss for posterior procedures, including L5–S1 transsacral interbody fusion (and in some cases L4–5 and L5–S1 transsacral interbody fusion) and percutaneous screw fixation, was 231 ml (range 50–400 ml). The mean operating time, which was recorded from incision time to closure, was 232 minutes (range 104–448 minutes) for the anterior procedures, and for posterior procedures it was 248 minutes (range 141–370 minutes). The mean length of hospital stay was 10 days (range 3–20 days). The preoperative Cobb angle was 22° (range 15–62°), which corrected to 7° (range 0–22°). All patients maintained correction of their deformity and were noted to have solid arthrodesis on plain radiographs. This was further confirmed on CT scans in 21 patients. The mean preoperative visual analog scale and treatment intensity scale scores were 7.05 and 53.5; postoperatively these were 3.03 and 25.88, respectively. The mean preoperative 36-Item Short Form Health Survey and Oswestry Disability Index scores were 55.73 and 39.13; postoperatively they were 61.50 and 7, respectively. In terms of major complications, 2 patients had quadriceps palsies from which they recovered within 6 months, 1 sustained a retrocapsular renal hematoma, and 1 patient had an unrelated cerebellar hemorrhage.
Conclusions
Minimally invasive surgical correction of adult scoliosis results in mid- to long-term outcomes similar to traditional surgical approaches. Whereas operating times are comparable to those achieved with open approaches, blood loss and morbidity appear to be significantly lower in patients undergoing minimally invasive deformity correction. This approach may be particularly useful in the elderly.
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Affiliation(s)
| | | | - Bhavraj Khalsa
- 2University of California Irvine School of Medicine, Irvine, California
| | - Eli M. Baron
- 3Neurosurgery, Cedars Sinai Spine Center, Cedars Sinai Medical Center, Los Angeles; and
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Li M, Ni J, Li Y, Fang X, Gu S, Zhang Z, Zhu X. Single-staged anterior and posterior spinal fusion: a safe and effective alternative for severe and rigid adolescent idiopathic scoliosis in China. J Paediatr Child Health 2009; 45:246-53. [PMID: 19493115 DOI: 10.1111/j.1440-1754.2009.01491.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM Delayed treatment of adolescent idiopathic scoliosis (AIS) is common in Mainland China because of the lack of public education about health care resulting in the reluctance to undergo surgery. This leads to a high incidence of complex cases where surgeons may not be trained in advanced procedures. We report the efficacy of single-staged anterior and posterior spinal fusion for correction of severe AIS in China. METHODS A retrospective review was performed of 31 consecutive cases in which patients were treated at the Orthopaedic Department of Changhai Hospital in Shanghai between 2001 and 2004 with a combined anterior and posterior spinal fusion with screws, hooks, sublaminar wires or cables. RESULTS Thirty-one patients with AIS with Lenke type 1, 2, 3 and 4 curves were included for analysis. At least one of the curves was >or=90 degrees in each patient. The mean coronal and sagittal Cobb angles of the main thoracic curve were 98 degrees and 22 degrees before surgery, 50.5 degrees and 21 degrees after surgery, and 53.7 degrees and 24 degrees at follow-up, respectively. No neurological deficits or deaths occurred. Solid arthrodesis with coronal and sagittal balance was achieved in all patients. CONCLUSIONS A single-stage anterior release and fusion and posterior fusion for treatment of severe AIS is good alternative to pedicle screws/vertebrectomy on the basis of risk-benefit balance, and can be performed by surgeons not experienced in more complex procedures. The risk of pulmonary complications may be preferable to the risk of severe neurological complications when thoracic pedicle screws are applied, especially when surgeons are not adequately trained in their use.
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Affiliation(s)
- Ming Li
- Department of Orthopedics, Changhai Hospital, Second Military Medical University, Shanghai, China
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Peelle MW, Boachie-Adjei O, Charles G, Kanazawa Y, Mesfin A. Lumbar curve response to selective thoracic fusion in adult idiopathic scoliosis. Spine J 2008; 8:897-903. [PMID: 18261962 DOI: 10.1016/j.spinee.2007.11.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2007] [Revised: 09/27/2007] [Accepted: 11/20/2007] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT To date, no study has critically examined the radiographic characteristics of the lumbar curve after selective thoracic fusion for the adult idiopathic scoliosis patient population. PURPOSE To evaluate the radiographic response of the lumbar curve to selective thoracic fusion in the adult scoliosis population with correlative clinical outcomes. STUDY DESIGN Retrospective case series. PATIENT SAMPLE Thirty patients with idiopathic scoliosis surgically treated at a mean age of 40 years (range, 20-66) using a posterior translational technique. OUTCOME MEASURES Radiographic review and functional outcome assessment. METHODS A retrospective, minimum 2-year follow-up, radiographic, and clinical review. All patients underwent selective thoracic posterior fusion with end-instrumented vertebra at T11 (1), T12 (7), L1 (14), and L2 (8). RESULTS At a mean follow-up of 39 (range, 24-87) months, spontaneous lumbar curve Cobb improvement (36 degrees -18 degrees = 50% correction) was less than the bending radiograph (12 degrees , 68% correction). Lowest-instrumented vertebra (LIV) tilt angle improved from 24 to 9 degrees and LIV disc angle improved from 8 to 4 degrees (p < .001). Lumbar apical disc angle improved from 10 to 7 degrees (p < .001). Lumbar apical vertebral translation remained unchanged from pre-op (17 mm) to latest follow-up (17 mm) (p = .23). Lumbar curve rotation increased from 8 to 10 degrees (p = .11). One patient had coronal imbalance of greater than 3 cm and two patients had greater than 3 cm of negative sagittal imbalance. Mean subgroup scores of the Scoliosis Research Society-22 questionnaire improved (p < .01) for pain (3.0-3.8) and self-image (2.5-4.0) but remained the same for function and mental health. Only one patient required extension of fusion to include the lumbar curve 6 years postoperatively. CONCLUSIONS The lumbar curve response in adult, selective thoracic scoliosis surgery is characterized by 1) moderate correction but less than the bending film Cobb; 2) greater change in LIV tilt and disc angle than apical vertebra disc angle; 3) no change in lumbar apical translation or rotation; 4) more significant disc height preservation at the LIV compared with lumbar apex. Good clinical outcomes can be achieved with posterior translational instrumentation in adult scoliosis patients.
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Weiss HR, Goodall D. Rate of complications in scoliosis surgery - a systematic review of the Pub Med literature. SCOLIOSIS 2008; 3:9. [PMID: 18681956 PMCID: PMC2525632 DOI: 10.1186/1748-7161-3-9] [Citation(s) in RCA: 143] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2008] [Accepted: 08/05/2008] [Indexed: 01/03/2023]
Abstract
Background Spinal fusion surgery is currently recommended when curve magnitude exceeds 40–45 degrees. Early attempts at spinal fusion surgery which were aimed to leave the patients with a mild residual deformity, failed to meet such expectations. These aims have since been revised to the more modest goals of preventing progression, restoring 'acceptability' of the clinical deformity and reducing curvature. In view of the fact that there is no evidence that health related signs and symptoms of scoliosis can be altered by spinal fusion in the long-term, a clear medical indication for this treatment cannot be derived. Knowledge concerning the rate of complications of scoliosis surgery may enable us to establish a cost/benefit relation of this intervention and to improve the standard of the information and advice given to patients. It is also hoped that this study will help to answer questions in relation to the limiting choice between the risks of surgery and the "wait and see – observation only until surgery might be recommended", strategy widely used. The purpose of this review is to present the actual data available on the rate of complications in scoliosis surgery. Materials and methods Search strategy for identification of studies; Pub Med and the SOSORT scoliosis library, limited to English language and bibliographies of all reviewed articles. The search strategy included the terms; 'scoliosis'; 'rate of complications'; 'spine surgery'; 'scoliosis surgery'; 'spondylodesis'; 'spinal instrumentation' and 'spine fusion'. Results The electronic search carried out on the 1st February 2008 with the key words "scoliosis", "surgery", "complications" revealed 2590 titles, which not necessarily attributed to our quest for the term "rate of complications". 287 titles were found when the term "rate of complications" was used as a key word. Rates of complication varied between 0 and 89% depending on the aetiology of the entity investigated. Long-term rates of complications have not yet been reported upon. Conclusion Scoliosis surgery has a varying but high rate of complications. A medical indication for this treatment cannot be established in view of the lack of evidence. The rate of complications may even be higher than reported. Long-term risks of scoliosis surgery have not yet been reported upon in research. Mandatory reporting for all spinal implants in a standardized way using a spreadsheet list of all recognised complications to reveal a 2-year, 5-year, 10-year and 20-year rate of complications should be established. Trials with untreated control groups in the field of scoliosis raise ethical issues, as the control group could be exposed to the risks of undergoing such surgery.
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Affiliation(s)
- Hans-Rudolf Weiss
- Asklepios Katharina Schroth Spinal Deformities Rehabilitation Centre, Korczakstr, 2, D-55566, Bad Sobernheim, Germany.
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Partially overlapping limited anterior and posterior instrumentation for adult thoracolumbar and lumbar scoliosis: a description of novel spinal instrumentation, "the hybrid technique". HSS J 2007; 3:93-8. [PMID: 18751777 PMCID: PMC2504101 DOI: 10.1007/s11420-006-9038-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Progressive and/or painful adult spinal deformity in the thoracolumbar and lumbar spine is sometimes treated surgically by long posterior fusions from the thoracic spine down to the pelvis, especially where there is a major thoracic curve component. Recent advances in anterior spinal instrumentation and spinal surgery technique have demonstrated the improved corrective ability offered by anterior stabilization systems, and the added benefit of limiting the number of vertebral fusion levels required for control of the deformity. The "hybrid technique" is a novel use of anterior instrumentation that applies limited anterior instrumentation down to the low lumbar spine (rods and screws), and partially overlapping short-segment posterior instrumentation to the sacrum (pedicle screws and rods). These constructs avoid posterior thoracic instrumentation and fusions, and avoid extension of posterior instrumentation to the pelvis. In the first 10 patients treated using this technique, thoracolumbar and lumbar major curve correction has averaged 71 and 82% in the immediate postoperative period (n = 7), respectively, and 59 and 68% at 2-year follow-up, respectively. The technique is an appealing and attractive alternative for treatment of thoracolumbar and lumbar scoliosis in the adult population, and avoids the requirement for applying spinal fixation to the thoracic spine and the pelvis.
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Bess RS, Lenke LG. Blood loss minimization and blood salvage techniques for complex spinal surgery. Neurosurg Clin N Am 2007; 17:227-34, v. [PMID: 16876024 DOI: 10.1016/j.nec.2006.04.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Several techniques to limit blood loss and salvage lost blood are available to surgeons, physicians, and personnel who treat complex spinal disorders. These techniques include red blood cell augmentation, intraoperative antifibrinolytic administration, use of topical hemostatic agents, and intraoperative blood salvage and postoperative blood salvage. A substantial amount of research has been directed toward reducing perioperative blood loss in spinal surgery. More efforts need to be directed toward effective perioperative blood management in complex spinal surgery.
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Affiliation(s)
- R Shay Bess
- Department of Orthopaedic Surgery, University of Utah Hospitals and Clinics, University Orthopaedic Center, 590 Wakara Way, Salt Lake City, UT 84106, USA.
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Teli M, Elsebaie H, Biant L, Noordeen H. Neuromuscular scoliosis treated by segmental third-generation instrumented spinal fusion. ACTA ACUST UNITED AC 2006; 18:430-8. [PMID: 16189456 DOI: 10.1097/01.bsd.0000171873.99803.9f] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We aimed to investigate whether the outcome and complications of surgical treatment of neuromuscular curves with segmental third-generation instrumentation could compare with those reported with standard second-generation instrumentation. The clinical and radiologic data of a single surgeon's consecutive series of patients with neuromuscular scoliosis treated with two types of newer-generation instrumentation and posterior or anteroposterior approaches were retrospectively and independently reviewed. The results of this study support the concept that third-generation instrumentation is able to provide at least as good results as second-generation instrumentation in the treatment of neuromuscular scoliosis patients, at the expense of a lower complication rate.
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Affiliation(s)
- Marco Teli
- Great Ormond Street Hospital for Sick Children, London and Royal National Orthopaedic Hospital, Stanmore, UK.
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Aebi M. The adult scoliosis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2005; 14:925-48. [PMID: 16328223 DOI: 10.1007/s00586-005-1053-9] [Citation(s) in RCA: 543] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2005] [Accepted: 10/26/2005] [Indexed: 01/29/2023]
Abstract
Adult scoliosis is defined as a spinal deformity in a skeletally mature patient with a Cobb angle of more than 10 degrees in the coronal plain. Adult scoliosis can be separated into four major groups: Type 1: Primary degenerative scoliosis, mostly on the basis of a disc and/or facet joint arthritis, affecting those structures asymmetrically with predominantly back pain symptoms, often accompanied either by signs of spinal stenosis (central as well as lateral stenosis) or without. These curves are often classified as "de novo" scoliosis. Type 2: Idiopathic adolescent scoliosis of the thoracic and/or lumbar spine which progresses in adult life and is usually combined with secondary degeneration and/or imbalance. Some patients had either no surgical treatment or a surgical correction and fusion in adolescence in either the thoracic or thoracolumbar spine. Those patients may develop secondary degeneration and progression of the adjacent curve; in this case those curves belong to the type 3a. Type 3: Secondary adult curves: (a) In the context of an oblique pelvis, for instance, due to a leg length discrepancy or hip pathology or as a secondary curve in idiopathic, neuromuscular and congenital scoliosis, or asymmetrical anomalies at the lumbosacral junction; (b) In the context of a metabolic bone disease (mostly osteoporosis) combined with asymmetric arthritic disease and/or vertebral fractures. Sometimes it is difficult to decide, what exactly the primary cause of the curve was, once it has significantly progressed. However, once an asymmetric load or degeneration occurs, the pathomorphology and pathomechanism in adult scoliosis predominantly located in the lumbar or thoracolumbar spine is quite predictable. Asymmetric degeneration leads to increased asymmetric load and therefore to a progression of the degeneration and deformity, as either scoliosis and/or kyphosis. The progression of a curve is further supported by osteoporosis, particularly in post-menopausal female patients. The destruction of facet joints, joint capsules, discs and ligaments may create mono- or multisegmental instability and finally spinal stenosis. These patients present themselves predominantly with back pain, then leg pain and claudication symptoms, rarely with neurological deficit, and almost never with questions related to cosmetics. The diagnostic evaluation includes static and dynamic imaging, myelo-CT, as well as invasive diagnostic procedures like discograms, facet blocks, epidural and root blocks and immobilization tests. These tests may correlate with the clinical and the pathomorphological findings and may also offer the least invasive and most rational treatment for the patient. The treatment is then tailored to the specific symptomatology of the patient. Surgical management consists of either decompression, correction, stabilization and fusion procedures or a combination of all of these. Surgical procedure is usually complex and has to deal with a whole array of specific problems like the age and the general medical condition of the patient, the length of the fusion, the condition of the adjacent segments, the condition of the lumbosacral junction, osteoporosis and possibly previous scoliosis surgery, and last but not least, usually with a long history of chronified back pain and muscle imbalance which may be very difficult to be influenced. Although this surgery is demanding, the morbidity cannot be considered significantly higher than in other established orthopaedic procedures, like hip replacement, in the same age group of patients. Overall, a satisfactory outcome can be expected in well-differentiated indications and properly tailored surgical procedures, although until today prospective, controlled studies with outcome measures and pre- and post-operative patient's health status are lacking. As patients, who present themselves with significant clinical problems in the context of adult scoliosis, get older, minimal invasive procedures to address exactly the most relevant clinical problem may become more and more important, basically ignoring the overall deformity and degeneration of the spine.
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Affiliation(s)
- Max Aebi
- Institute for Evaluative Research in Orthopaedic Surgery, University of Bern, Bern, Switzerland.
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Lonner BS, Murthy SK, Boachie-Adjei O. Single-staged double anterior and posterior spinal reconstruction for rigid adult spinal deformity: a report of four cases. Spine J 2005; 5:104-8. [PMID: 15739277 DOI: 10.1016/j.spinee.2004.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Sequential anterior/posterior spinal reconstruction for rigid adult spinal deformity has become a standard operative option. Single-staged double anterior/posterior spinal reconstruction for rigid double major curvature has not been reported in the literature to date. PURPOSE To report a previously unreported approach for rigid double major curvature of the thoracic and thoracolumbar spine with emphasis on indications and avoiding complications. STUDY DESIGN Four cases of sequential double anterior/posterior spinal reconstruction are reported. METHODS Single-staged double anterior spinal reconstruction was performed on four adult patients with rigid thoracic and thoracolumbar scoliosis. Osteotomies were performed by the anterior and posterior approach and followed by posterior instrumentation. A right thoracotomy and left retropleural/retroperitoneal approach was performed for each patient followed by the posterior approach in a single stage. RESULTS Only one complication occurred, a posterior dural tear, treated without incident. A high level of patient satisfaction and return to activity was noted. Solid arthrodesis with good coronal and sagittal balance occurred in all patients. CONCLUSIONS Single-staged double anterior/posterior spinal reconstruction for rigid adult deformity can be performed safely and effectively with good patient outcome. The procedure should be reserved only for those patients with severe double major curvature of similar magnitude and rigidity.
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Affiliation(s)
- Baron S Lonner
- Department of Orthopedic Surgery, Hospital for Joint Diseases, 301 E. 17th Street, New York, NY 10003, USA.
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