Comparison of Outcomes Between Staged and Same-Day Circumferential Spinal Fusion for Adult Spinal Deformity: Systematic Review and Meta-Analysis

BACKGROUND

Adult spinal deformity (ASD) is a prevalent condition often treated with circumferential spinal fusion (CF), which can be performed as staged or same-day procedures. However, evidence guiding the choice between these approaches is lacking.

OBJECTIVE

This study aims to compare patient outcomes following staged and same-day CF for ASD.

METHODS

Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a comprehensive literature search was conducted in PubMed, MEDLINE, Embase, Cochrane CENTRAL, Web of Science, and Scopus. Eligibility criteria included studies comparing outcomes following staged and same-day CF in adults with ASD. Searches were exported to Covidence, and records were deduplicated automatically. Title and abstract screening, full-text review, and data extraction were performed by two independent reviewers, with all conflicts being resolved by a third reviewer. A meta-analysis was conducted for outcomes reported in 3 or more studies.

RESULTS

Seven studies with 741 patients undergoing CF for ASD were included in the review (staged: n=331, 44.7% and same-day: n=410, 55.3%). Four studies that had comparable outcomes were merged for the quantitative meta-analysis and split based on observed measures. The meta-analysis revealed significantly shorter hospital length of stay (mean difference 3.98, 95% CI 2.23-5.72 days; P<.001) for same-day CF. Three studies compared the operative time between staged and same-day CF, with all reporting a lower mean operative time for same-day CF (mean between 291-479, SD 129 minutes) compared to staged CF (mean between 426-541, SD 124 minutes); however, inconsistent reporting of mean and SD made quantitative analyses unattainable. Of the 4 studies that compared estimated blood loss (EBL) in the relevant groups, 3 presented a lower EBL (mean between 412-1127, SD 954 mL) in same-day surgery compared to staged surgery (mean between 642, SD 550 to 1351, SD 869 mL). Both studies that reported intra- and postoperative adverse events showed more intraoperative adverse events in staged CF (10.9% and 13.6%, respectively) compared to same-day CF (9.1% and 3.6%, respectively). Four studies measuring any perioperative adverse events showed a higher incidence of adverse events in staged CF than all studies combined. However, quantitative analysis of EBL, intraoperative adverse events, and perioperative adverse events found no statistically significant difference. Postoperative adverse events, reoperation, infection rates, and readmission rates showed inconsistent findings between studies. Data quality assessment revealed a moderate degree of bias for all included studies.

CONCLUSIONS

Same-day CF may offer shorter operating time and hospital stay compared to staged CF for ASD. However, there was marked heterogeneity in perioperative outcomes reporting, and continuous variables were inconsistently presented. This underscored the need for standardized reporting of clinical variables and patient-reported outcomes and higher evidence of randomized controlled trials to elucidate the clinical superiority of either approach.

TRIAL REGISTRATION

PROSPERO CRD42022339764; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=339764.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/42331.

Adult Spinal Deformity: A Comprehensive Review of Current Advances and Future Directions

Owing to rapidly changing global demographics, adult spinal deformity (ASD) now accounts for a significant proportion of the Global Burden of Disease. Sagittal imbalance caused by age-related degenerative changes leads to back pain, neurological deficits, and deformity, which negatively affect the health-related quality of life (HRQoL) of patients. Along with the recognized regional, global, and sagittal spinopelvic parameters, poor paraspinal muscle quality has recently been acknowledged as a key determinant of the clinical outcomes of ASD. Although the Scoliosis Research Society-Schwab ASD classification system incorporates the radiological factors related to HRQoL, it cannot accurately predict the mechanical complications. With the rapid advances in surgical techniques, many surgical options for ASD have been developed, ranging from minimally invasive surgery to osteotomies. Therefore, structured patient-specific management is important in surgical decision-making, selecting the proper surgical technique, and to prevent serious complications in patients with ASD. Moreover, utilizing the latest technologies such as robotic-assisted surgery and machine learning, should help in minimizing the surgical risks and complications in the future.