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Pellisé F, Bayo MC, Ruiz de Villa A, Núñez-Pereira S, Haddad S, Barcheni M, Pizones J, Valencia MR, Obeid I, Alanay A, Kleinstueck FS, Mannion AF. The Impact of Unplanned Reoperation Following Adult Spinal Deformity Surgery: A Prospective Longitudinal Cohort Study with 5-Year Follow-up. J Bone Joint Surg Am 2024; 106:681-689. [PMID: 38630053 DOI: 10.2106/jbjs.23.00242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
BACKGROUND The long-term impact of reoperations following adult spinal deformity (ASD) surgery is still poorly understood. Our aim was to identify the relationship between unplanned reoperation and health-related quality of life (HRQoL) gain at 2 and 5 years of follow-up. METHODS We included patients enrolled in a prospective ASD database who underwent surgery ≥5 years prior to the start of the study and who had 2 years of follow-up data. Adverse events (AEs) leading to an unplanned reoperation, the time of reoperation occurrence, invasiveness (blood loss, surgical time, hospital stay), and AE resolution were assessed. HRQoL was measured with use of the Oswestry Disability Index, Scoliosis Research Society-22, and Short Form-36. Linear models controlling for baseline data and index surgery characteristics were utilized to assess the relationships between HRQoL gain at 2 and 5-year follow-up and the number and invasiveness of reoperations. The association between 5-year HRQoL gain and the time of occurrence of the unplanned reoperation and that between 5-year HRQoL gain and AE resolution were also investigated. RESULTS Of 361 eligible patients, 316 (87.5%) with 2-year follow-up data met the inclusion criteria and 258 (71.5%) had 5-year follow-up data. At the 2-year follow-up, 96 patients (30.4%) had a total of 165 unplanned reoperations (1.72 per patient). At the 5-year follow-up, 73 patients (28.3%) had a total of 117 unplanned reoperations (1.60 per patient). The most common cause of reoperations was mechanical complications (64.9%), followed by surgical site infections (15.7%). At the 5-year follow-up, the AE that led to reoperation was resolved in 67 patients (91.8%). Reoperation invasiveness was not associated with 5-year HRQoL scores. The number of reoperations was associated with lesser HRQoL gain at 5 years for all HRQoL measures. The mean associated reduction in HRQoL gain per unplanned reoperation was 41% (range, 19% to 66%). Reoperations resulting in no resolution of the AE or resolution with sequelae had a greater impact on 5-year follow-up HRQoL scores than reoperations resulting in resolution of the AE. CONCLUSIONS A postoperative, unplanned reoperation following ASD surgery was associated with lesser gain in HRQoL at 5 years of follow-up. The association did not diminish over time and was affected by the number, but not the magnitude, of reoperations. Resolution of the associated AE reduced the impact of the unplanned reoperation. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Ferran Pellisé
- Spine Surgery Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | | | | | - Sleiman Haddad
- Spine Surgery Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Maggie Barcheni
- Spine Research Unit, Vall d'Hebron Research Institute, Barcelona, Spain
| | | | | | | | - Ahmet Alanay
- Department of Orthopaedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | | | - Anne F Mannion
- Spine Center Division, Schulthess Klinik, Zurich, Switzerland
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Varshneya K, Stienen MN, Medress ZA, Fatemi P, Pendharkar AV, Ratliff JK, Veeravagu A. Risk Factors for Revision Surgery After Primary Adult Thoracolumbar Deformity Surgery. Clin Spine Surg 2022; 35:E94-E98. [PMID: 33443943 DOI: 10.1097/bsd.0000000000001124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 11/07/2020] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This is a retrospective cohort study. OBJECTIVE The aim was to identify the risk factors for revision surgery within 2 years of patients undergoing primary adult spinal deformity (ASD) surgery. SUMMARY OF BACKGROUND DATA Previous literature reports estimate 20% of patients undergoing thoracolumbar ASD correction undergo reoperation within 2 years. There is limited published data regarding specific risk factors for reoperation in ASD surgery in the short term and long term. METHODS The authors queried the MarketScan database in order to identify patients who were diagnosed with a spinal deformity and underwent ASD surgery from 2007 to 2015. Patient-level factors and revision risk were investigated during 2 years after primary ASD surgery. Patients under the age of 18 years and those with any prior history of trauma or tumor were excluded from this study. RESULTS A total 7422 patients underwent ASD surgery during 2007-2015 in the data set. Revision rates were 13.1% at 90 days, 14.5% at 6 months, 16.7% at 1 year, and 19.3% at 2 years. In multivariate multiple logistic regression analysis, obesity [adjusted odds ratio (OR): 1.58, P<0.001] and tobacco use (adjusted OR: 1.38, P=0.0011) were associated with increased odds of reoperation within 2 years. Patients with a combined anterior-posterior approach had lower odds of reoperation compared with those with posterior only approach (adjusted OR: 0.66, P=0.0117). CONCLUSIONS Obesity and tobacco are associated with increased odds of revision surgery within 2 years of index ASD surgery. Male sex and combined surgical approach are associated with decreased odds of revision surgery.
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Affiliation(s)
- Kunal Varshneya
- Neurosurgery AI Laboratory and Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA
| | - Martin N Stienen
- Neurosurgery AI Laboratory and Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA
- Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - Zachary A Medress
- Neurosurgery AI Laboratory and Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA
| | - Parastou Fatemi
- Neurosurgery AI Laboratory and Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA
| | - Arjun V Pendharkar
- Neurosurgery AI Laboratory and Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA
| | - John K Ratliff
- Neurosurgery AI Laboratory and Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA
| | - Anand Veeravagu
- Neurosurgery AI Laboratory and Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA
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Bari TJ, Karstensen S, Sørensen MD, Gehrchen M, Street J, Dahl B. Revision surgery and mortality following complex spine surgery: 2-year follow-up in a prospective cohort of 679 patients using the Spine AdVerse Event Severity (SAVES) system. Spine Deform 2020; 8:1341-1351. [PMID: 32607936 DOI: 10.1007/s43390-020-00164-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 06/19/2020] [Indexed: 12/22/2022]
Abstract
STUDY DESIGN Prospective study. OBJECTIVE To determine the 2-year risk of revision surgery and all-cause mortality after complex spine surgery, and to assess if prospectively registered adverse events (AE) could predict either outcome. Revision surgery and mortality are serious complications to spine surgery. Previous studies of frequency have mainly been retrospective and few studies have employed competing risk survival analyses. In addition, assessment of predictors has focused on preoperative patient characteristics. The effect of perioperative AEs on revision and all-cause mortality risks are not fully understood. METHODS Between January 1 and December 31, 2013, we prospectively included all patients undergoing complex spine surgery at a single, tertiary institution. Complex spine surgery was defined as conditions deemed too complicated for surgery at a secondary institute, or patients with severe comorbidities requiring multidisciplinary observation and treatment. AEs were registered using the Spine Adverse Event Severity system and patients were followed for minimum 2 years regarding revision surgery and all-cause mortality. Incidences were estimated using competing risk survival analyses and correlation between AEs and either outcome was assessed using proportional odds models. RESULTS We included a complete and consecutive cohort of 679 adult and pediatric patients. Demographics, surgical data, AEs, and events of revision or all-cause mortality were registered. The cumulative incidence of 2-year all-cause revision was 19% (16-22%) and all-cause mortality was 15% (12-18%). Deformity surgery was the surgical category with highest incidence of revision and the highest incidence of all-cause mortality was seen in the tumor group. Across surgical categories, cumulative incidences of 2-year revision ranged between 11% (tumor) and 33% (deformity), whilst 2-year all-cause mortality ranged between 3% (deformity) and 33% (tumor). We found that major intraoperative AEs were associated to increased odds of revision. Deep wound infection was associated to increased odds of all-cause mortality. CONCLUSIONS We report the cumulative incidences of revision surgery and all-cause mortality following complex spine surgery. We found higher incidences of revision compared to previous retrospective studies. Prospectively registered AEs were correlated to increased odds of revision surgery and all-cause mortality. These results may serve as reference for future interventional studies and aid in identifying at-risk patients. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Tanvir Johanning Bari
- Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Sven Karstensen
- Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Mathias Dahl Sørensen
- Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Martin Gehrchen
- Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - John Street
- Combined Neurosurgical and Orthopedic Spine Program, Vancouver General Hospital, University of British Columbia, Floor 6, Blusson Spinal Cord Center, 818 West 10th Ave., Vancouver, BC, V5Z 1M9, Canada
| | - Benny Dahl
- Department of Orthopedics and Scoliosis Surgery, Texas Children's Hospital and Baylor College of Medicine, 6621 Fannin St, Houston, TX, 77030, USA
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Bari TJ, Hansen LV, Gehrchen M. Surgical correction of Adult Spinal Deformity in accordance to the Roussouly classification: effect on postoperative mechanical complications. Spine Deform 2020; 8:1027-37. [PMID: 32279244 DOI: 10.1007/s43390-020-00112-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 03/25/2020] [Indexed: 12/13/2022]
Abstract
STUDY DESIGN Single-center, retrospective. OBJECTIVES To assess the restoration of ideal sagittal spine shape in accordance to the Roussouly classification and the effect on postoperative mechanical complications. Surgical correction of Adult Spinal Deformity is both challenging and complex. The risk of postoperative complications is considerable, especially mechanical complications requiring revision surgery. Attention has been directed toward defining alignment targets in attempts to minimize these risks, and the Roussouly classification has been proposed as a potential surgical aim. METHODS All patients undergoing ASD surgery from 2013-2016 were included at a single, quaternary institute. Successful restoration of Roussouly spine shape was retrospectively assessed, and patients were classified as either "restored" or "non-restored". Cumulative incidence of revision surgery due to mechanical failure was estimated using the Aalen-Johansen estimator, with death as the competing risk. A multivariable proportional odds model was used to estimate the effect of the Roussouly algorithm on revision surgery due to mechanical failure. RESULTS We identified a complete and consecutive cohort of 233 patients who were followed for a mean period of 36 (± 14) months. The 2-year cumulative incidence of revision surgery was 28%. Comparing the "restored" to the "non-restored" group, the overall revision rates were high in both groups. However, when adjusting for known cofounders in a multivariable proportional odds analysis, there was an almost fivefold increased odds of revision due to mechanical failure in the "non-restored" group (p = 0.036). CONCLUSION Surgical correction of ASD in accordance to the ideal Roussouly spine shape was correlated to a marked and significant decrease in risk of revision surgery due to mechanical failure. Nonetheless, the overall revision risk was elevated in both groups. LEVEL OF EVIDENCE Therapeutic III.
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Overbergh T, Severijns P, Beaucage-gauvreau E, Jonkers I, Moke L, Scheys L. Development and validation of a modeling workflow for the generation of image-based, subject-specific thoracolumbar models of spinal deformity. J Biomech 2020; 110:109946. [DOI: 10.1016/j.jbiomech.2020.109946] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 11/24/2022]
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Le Huec JC, Seresti S, Bourret S, Cloche T, Monteiro J, Cirullo A, Roussouly P. Revision after spinal stenosis surgery. Eur Spine J 2020; 29:22-38. [PMID: 31997016 DOI: 10.1007/s00586-020-06314-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 01/17/2020] [Accepted: 01/19/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE To make a literature review on spinal stenosis recurrence after a first surgery and edit rules to avoid this complication. METHODS We conducted two separate PUBMED searches to evaluate the revision post-stenosis and degenerative scoliosis surgery using the terms: lumbar vertebrae/surgery, spinal stenosis, spine, scoliosis and reoperation. The resulting papers were categorized into three groups: (1) those that evaluated reoperation post-simple decompression; (2) those that evaluated spinal decompression and fusion for short (3 levels or less) or long (more than 3 levels) segment spinal fusion; and (3) those diagnosing the stenosis during the surgery. RESULTS (1) We found 11 relevant papers that only looked at revision spine surgery post-laminectomy for spinal stenosis. (2) We found 20 papers looked at reoperation post-laminectomy and fusion amongst which there were two papers specifically comparing long-segment (> 3 level) and short-segment (3 or less levels) fusions. (3) In the unspecified group, we found only one article. Fifteen articles were excluded as they were not specifically looking at our objective criteria for revision surgery. In regard to revision post-adult deformity surgery, we found 18 relevant articles. CONCLUSIONS After this literature review and analysis of post-operative stenosis, it seems important to provide some advice to avoid revision surgeries more or less induced by the surgery. It looks interesting when performing simple decompression without fusion in the lumbar spine to analyse the risk of instability induced by the decompression and facet resection but also by a global balance analysis. Regarding pre-operative stenosis in a previously operated area, different causes may be evocated, like screw or cage malpositionning but also insufficient decompression which is a common cause. Intraoperatively, the use of neuromonitoring and intraoperative CT scan with navigation are useful tool in complex cases to avoid persisting stenosis. Pre-op analysis and planning are key parameters to decrease post-op problems. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- J C Le Huec
- Polyclinique Bordeaux Nord Aquitaine, Centre Vertebra, Bordeaux Univ, 15 Rue Boucher, 33000, Bordeaux, France.
| | - S Seresti
- Polyclinique Bordeaux Nord Aquitaine, Centre Vertebra, Bordeaux Univ, 15 Rue Boucher, 33000, Bordeaux, France
| | - S Bourret
- Polyclinique Bordeaux Nord Aquitaine, Centre Vertebra, Bordeaux Univ, 15 Rue Boucher, 33000, Bordeaux, France
| | - T Cloche
- Polyclinique Bordeaux Nord Aquitaine, Centre Vertebra, Bordeaux Univ, 15 Rue Boucher, 33000, Bordeaux, France
| | - J Monteiro
- Polyclinique Bordeaux Nord Aquitaine, Centre Vertebra, Bordeaux Univ, 15 Rue Boucher, 33000, Bordeaux, France
| | - A Cirullo
- Polyclinique Bordeaux Nord Aquitaine, Centre Vertebra, Bordeaux Univ, 15 Rue Boucher, 33000, Bordeaux, France
| | - P Roussouly
- Centre Des Massues, Croix Rouge, 92 Rue Dr Ed Locard, 69005, Lyon, France
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Pitter FT, Lindberg-Larsen M, Pedersen AB, Dahl B, Gehrchen M. Revision Risk After Primary Adult Spinal Deformity Surgery: A Nationwide Study With Two-Year Follow-up. Spine Deform 2019; 7:619-626.e2. [PMID: 31202380 DOI: 10.1016/j.jspd.2018.10.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 09/06/2018] [Accepted: 10/21/2018] [Indexed: 11/15/2022]
Abstract
STUDY DESIGN Cohort study. OBJECTIVES To report the two-year revision risk following primary adult spinal deformity (ASD) surgery, describe reasons for revisions, and assess risk factors for revision surgery. SUMMARY OF BACKGROUND DATA Revision risk following primary ASD surgery has been reported to vary between 7% and 26%, but with loss to follow-up as a considerable challenge. METHODS Patients ≥18 years of age undergoing primary instrumented surgery for ASD in Denmark during 2006-2014 were identified by procedure and diagnosis codes in the Danish National Patient Registry (DNPR). Complete two-year follow-up on revision surgery for each patient was achieved. Medical records were reviewed to determine reasons for revisions. Overall comorbidity was summarized using the Charlson Comorbidity Index (CCI) based on DNPR data; low comorbidity (CCI 0); medium comorbidity (CCI 1-2); and high comorbidity (CCI ≥3). Risk factors for revision were assessed in a Cox regression model. RESULTS A total of 553 patients were identified. Of these, 19.9% were revised within the two-year follow-up and 7.2% of patients were revised more than once. Median time to revision was 308 days (interquartile range 105-508). The most common reason for revision was implant failure (38.2%) followed by infection (11.8%). Increased age (hazard ratio [HR] = 1.13, 95% confidence interval [CI] 1.01-1.26, per 10 years increment) and high comorbidity burden (HR = 2.10, 95% CI 1.16-3.79) were associated with increased revision risk. Risk of revision increased from 2006 to 2014; hence, year of primary surgery (with 2006 as reference) was associated with increased revision risk (HR = 1.09, 95% CI 1.01-1.18). CONCLUSIONS The revision risk within 2 years after primary ASD surgery was 19.9% nationwide in Denmark, and implant failure was the most common reason for revision. Increased comorbidity and age were separately associated with increased risk of revision. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Frederik T Pitter
- Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, University Hospital of Copenhagen, Blegdamsvej 9-2100, København Ø, Denmark.
| | - Martin Lindberg-Larsen
- Department of Orthopedic Surgery and Traumatology, Odense University Hospital, J.B. Winsløvsvej 4-5000, Odense C, Denmark
| | - Alma B Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45-8200, Aarhus N, Denmark
| | - Benny Dahl
- Department of Orthopedic Surgery, Texas Children's Hospital & Baylor College of Medicine, Houston, TX 77030, USA
| | - Martin Gehrchen
- Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, University Hospital of Copenhagen, Blegdamsvej 9-2100, København Ø, Denmark
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Eastlack RK, Srinivas R, Mundis GM, Nguyen S, Mummaneni PV, Okonkwo DO, Kanter AS, Anand N, Park P, Nunley P, Uribe JS, Akbarnia BA, Chou D, Deviren V. Early and Late Reoperation Rates With Various MIS Techniques for Adult Spinal Deformity Correction. Global Spine J 2019; 9:41-47. [PMID: 30775207 PMCID: PMC6362559 DOI: 10.1177/2192568218761032] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN A multicenter retrospective review of an adult spinal deformity database. OBJECTIVE We aimed to characterize reoperation rates and etiologies of adult spinal deformity surgery with circumferential minimally invasive surgery (cMIS) and hybrid (HYB) techniques. METHODS Inclusion criteria were age ≥18 years, and one of the following: coronal Cobb >20°, sagittal vertical axis >5 cm, pelvic tilt >20°, and pelvic incidence-lumbar lordosis >10°. Patients with either cMIS or HYB surgery, ≥3 spinal levels treated with 2-year minimum follow-up were included. RESULTS A total of 133 patients met inclusion for this study (65 HYB and 68 cMIS). Junctional failure (13.8%) was the most common reason for reoperation in the HYB group, while fixation failure was the most common reason in the cMIS group (14.7%). There was a higher incidence of proximal junctional failure (PJF) than distal junctional failure (DJF) within HYB (12.3% vs 3.1%), but no significant differences in PJF or DJF rates when compared to cMIS. Early (<30 days) reoperations were less common (cMIS = 1.5%; HYB = 6.1%) than late (>30 days) reoperations (cMIS = 26.5%; HYB = 27.7%), but early reoperations were more common in the HYB group after propensity matching, largely due to infection rates (10.8% vs 0%, P = .04). CONCLUSIONS Adult spinal deformity correction with cMIS and HYB techniques result in overall reoperation rates of 27.9% and 33.8%, respectively, at minimum 2-year follow-up. Junctional failures are more common after HYB approaches, while pseudarthrosis/fixation failures happen more often with cMIS techniques. Early reoperations were less common than later returns to the operating room in both groups, but cMIS demonstrated less risk of infection and early reoperation when compared with the HYB group.
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Affiliation(s)
- Robert K. Eastlack
- Scripps Clinic, La Jolla, CA, USA,Robert K. Eastlack, Department of Orthopaedics, Scripps Clinic, 10666 N Torrey Pines Road, La Jolla, CA 92037, USA.
| | | | - Gregory M. Mundis
- Scripps Clinic, La Jolla, CA, USA,San Diego Spine Foundation, San Diego, CA, USA
| | | | | | | | - Adam S. Kanter
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Paul Park
- University of Michigan, Ann Arbor, MI, USA
| | | | | | | | - Dean Chou
- University of California, San Francisco, CA, USA
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Crawford CH, Glassman SD, Carreon LY, Shaffrey CI, Koski TR, Baldus CR, Bridwell KH. Prevalence and Indications for Unplanned Reoperations Following Index Surgery in the Adult Symptomatic Lumbar Scoliosis NIH-Sponsored Clinical Trial. Spine Deform 2018; 6:741-744. [PMID: 30348353 PMCID: PMC6201302 DOI: 10.1016/j.jspd.2018.04.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 04/18/2018] [Accepted: 04/21/2018] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN Longitudinal cohort. OBJECTIVE To report on the prevalence and indications for unplanned reoperations following index surgery in the Adult Symptomatic Lumbar Scoliosis NIH-sponsored Clinical Trial. SUMMARY OF BACKGROUND DATA Reoperation following adult spinal deformity surgery exposes the patient to additional surgical risk, increases the cost of care, and decreases the potential cost-effectiveness of the intervention. Accurate data regarding the prevalence and indication for reoperation will facilitate future efforts to minimize risk. METHODS A total of 153 patients underwent adult spinal deformity surgery as part of the observational, randomized, or crossover groups and were eligible for two-year follow-up. Reoperations were meticulously tracked as part of the National Institutes of Health (NIH)-mandated serious adverse event (SAE) reporting. The primary indication for reoperation was obtained from the treating surgeon's operative report. RESULTS Thirty-two patients had one reoperation, two patients underwent two reoperations, and three patients underwent three reoperations. A total of 45 reoperations were performed in 37 patients. Eleven patients (7%) underwent reoperation within 90 days of the index surgery: two for superficial wound dehiscence, three for radiculopathy with screw removal, and six for acute proximal junctional failure (PJF). Four patients underwent reoperation for PJF more than 90 days from index surgery. Twenty-six patients underwent 28 reoperations for rod fracture/pseudoarthrosis. CONCLUSION In a consecutive series of adult spinal deformity surgery patients with meticulous follow-up, 24% of patients required an unplanned reoperation. The most common indication for reoperation was rod fracture/pseudoarthrosis, which occurred from 9 months to 3.7 years following the index surgery and accounted for 62% (28/45) of the reoperations. The second most common indication for reoperation was PJF, which occurred from 1 month to 1.6 years following index surgery and accounted for 22% (10/45) of the reoperations. As these complications will likely increase with longer follow-up, efforts to lower the rates of these complications are warranted. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Charles H Crawford
- Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40202, USA; Department of Orthopaedic Surgery, University of Louisville School of Medicine, 550 S. Jackson St., 1st Floor ACB, Louisville, KY 40202, USA
| | - Steven D Glassman
- Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40202, USA; Department of Orthopaedic Surgery, University of Louisville School of Medicine, 550 S. Jackson St., 1st Floor ACB, Louisville, KY 40202, USA
| | - Leah Y Carreon
- Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40202, USA.
| | - Christopher I Shaffrey
- Department of Neurosurgery, University of Virginia, PO Box 800212, Charlottesville, VA 22908, USA
| | - Tyler R Koski
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, NMH/Arkes Family Pavilion Suite 2210, 676 N Saint Clair Street, Chicago, IL 60611, USA
| | - Christine R Baldus
- Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8233, St. Louis, MO 63110, USA
| | - Keith H Bridwell
- Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8233, St. Louis, MO 63110, USA
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Núñez-Pereira S, Vila-Casademunt A, Domingo-Sàbat M, Bagó J, Acaroglu ER, Alanay A, Obeid I, Sánchez Pérez-Grueso FJ, Kleinstück F, Pellisé F. Impact of early unanticipated revision surgery on health-related quality of life after adult spinal deformity surgery. Spine J 2018; 18:926-934. [PMID: 29037974 DOI: 10.1016/j.spinee.2017.09.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 09/13/2017] [Accepted: 09/26/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Revision surgery represents a major event for patients undergoing adult spinal deformity (ASD) surgery. Previous reports suggest that ASD surgery has minimal or no impact on health-related-quality of life (HRQOL) outcomes. PURPOSE The present study aims to investigate the impact of early reoperations within the first year on HRQOL and on the likelihood of reaching the minimally clinically important difference (MCID) after ASD surgery. DESIGN This is a retrospective analysis of prospectively collected data from consecutive surgically treated adult deformity surgery patients included in a multicenter, international database. PATIENT SAMPLE The present study included 280 patients from a multicenter international prospective database. OUTCOME MEASURE Oswestry Disability Index (ODI), Short Form-36 (SF-36), Scoliosis Research Society-22 (SRS-22), MCID were evaluated in this work. METHODS Consecutive surgical patients with ASD recruited prospectively in six different centers from four countries with a minimum 2-year follow-up were stratified into two groups: R (revision surgery within the first year) and NR (no revision). Health-related-quality of life (ODI, SF-36, SRS-22) was assessed and compared at 6-month, 1-year, and 2-year follow-up stages. Statistical analysis included chi-square tests, Student t tests, and linear mixed models. RESULTS Forty-three patients (R Group) received 46 revision surgeries. Nineteen patients (41.3%) had implant-related complications, 9 patients (19.6%) had deep surgical site infections, 9 patients (19.6%) had proximal junctional kyphosis, 3 patients (6.5%) had hematoma, and 6 patients (13%) had other complications. Baseline characteristics differed between groups. At 6 months, all HRQOL scores improved in both groups, except in the SF-36 Mental Component Summary and SRS-22 mental health domain in the R Group. At 1 year, ODI and SRS-22 improvement was significantly greater in the NR Group, exceeding the reported MCID. At the 2-year follow-up, ODI, SRS-22, SF-36 MCS, and SF-36 PCS improvement was similar in both groups. However, postoperative change was only above the MCID for SF-36 PCS, ODI, and SRS-22 in the NR Group. CONCLUSIONS Early unanticipated revision surgery has a negative impact on mental health at 6 months and reduces the chances of reaching an MCID improvement in SRS-22, SF-36 PCS, and ODI at the 2-year follow-up.
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Affiliation(s)
- Susana Núñez-Pereira
- Spine Research Unit, Vall d'Hebron Research Institute, VHIR Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain; Spine Surgery Department, St Franzkiskus Hospital, Schönsteinstr 63, 50825 Cologne, Germany.
| | - Alba Vila-Casademunt
- Spine Research Unit, Vall d'Hebron Research Institute, VHIR Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Montse Domingo-Sàbat
- Spine Research Unit, Vall d'Hebron Research Institute, VHIR Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Juan Bagó
- Spine Research Unit, Vall d'Hebron Research Institute, VHIR Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain; Spine Surgery Unit, Hospital Universitari Vall d'Hebron, Traumatology Building, 2nd Floor, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Emre R Acaroglu
- Orthopedic Spine Unit, Ankara Spine Center, Iran Caddesi 45/2 Kavaklidere, 06700 Ankara, Turkey
| | - Ahmet Alanay
- Department of Orthopaedics and Traumatology, Acibadem University School of Medicine, Katar cad. Kilic Sok, Istinye Park Kon, Kirlagic B Blok Daire 11, 34457 Istanbul, Turkey
| | - Ibrahim Obeid
- Spine Surgery Unit, Pellegrin University Hospital, 53 bis ave Maryse Bastié, 33520 Bruges, France
| | - Francisco Javier Sánchez Pérez-Grueso
- Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Traumatology Building, 3er floor, Paseo de la Castellana, 261, 28046 Madrid, Spain
| | - Frank Kleinstück
- Department of Orthopedics, Schulthess Klinik, Lengghalde 2, 8008 Zürich, Switzerland
| | - Ferran Pellisé
- Spine Research Unit, Vall d'Hebron Research Institute, VHIR Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain; Spine Surgery Unit, Hospital Universitari Vall d'Hebron, Traumatology Building, 2nd Floor, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
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How NE, Street JT, Dvorak MF, Fisher CG, Kwon BK, Paquette S, Smith JS, Shaffrey CI, Ailon T. Pseudarthrosis in adult and pediatric spinal deformity surgery: a systematic review of the literature and meta-analysis of incidence, characteristics, and risk factors. Neurosurg Rev 2019; 42:319-36. [PMID: 29411177 DOI: 10.1007/s10143-018-0951-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 01/18/2018] [Accepted: 01/25/2018] [Indexed: 01/11/2023]
Abstract
We conducted a systematic review with meta-analysis and qualitative synthesis. This study aims to characterize pseudarthrosis after long-segment fusion in spinal deformity by identifying incidence rates by etiology, risk factors for its development, and common features. Pseudarthrosis can be a painful and debilitating complication of spinal fusion that may require reoperation. It is poorly characterized in the setting of spinal deformity. The MEDLINE, EMBASE, and Cochrane databases were searched for clinical research including spinal deformity patients treated with long-segment fusions reporting pseudarthrosis as a complication. Meta-analysis was performed on etiologic subsets of the studies to calculate incidence rates for pseudarthrosis. Qualitative synthesis was performed to identify characteristics of and risk factors for pseudarthrosis. The review found 162 articles reporting outcomes for 16,938 patients which met inclusion criteria. In general, the included studies were of medium to low quality according to recommended reporting standards and study design. Meta-analysis calculated an incidence of 1.4% (95% CI 0.9-1.8%) for pseudarthrosis in adolescent idiopathic scoliosis, 2.2% (95% CI 1.3-3.2%) in neuromuscular scoliosis, and 6.3% (95% CI 4.3-8.2%) in adult spinal deformity. Risk factors for pseudarthrosis include age over 55, construct length greater than 12 segments, smoking, thoracolumbar kyphosis greater than 20°, and fusion to the sacrum. Choice of graft material, pre-operative coronal alignment, post-operative analgesics, and sex have no significant impact on fusion rates. Older patients with greater deformity requiring more extensive instrumentation are at higher risk for pseudarthrosis. Overall incidence of pseudarthrosis requiring reoperation is low in adult populations and very low in adolescent populations.
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Hallager DW, Karstensen S, Bukhari N, Gehrchen M, Dahl B. Radiographic Predictors for Mechanical Failure After Adult Spinal Deformity Surgery: A Retrospective Cohort Study in 138 Patients. Spine (Phila Pa 1976) 2017; 42:E855-63. [PMID: 27879571 DOI: 10.1097/BRS.0000000000001996] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort study at a single institution. OBJECTIVE We aimed at estimating the rate of revision procedures and identify radiographic predictors of mechanical failure after adult spinal deformity surgery. SUMMARY OF BACKGROUND DATA Mechanical failure rates after adult spinal deformity surgery range 12% to 37% in literature. Although the importance of spinal and spino-pelvic alignment is well documented for surgical outcome and ideal alignment has been proposed as sagittal vertical axis (SVA) < 5 cm, pelvic tilt < 20° and lumbar lordosis (LL) = pelvic incidence ± 9°, the role of radiographic sagittal spine parameters and alignment targets as predictors for mechanical failure remains uncertain. METHODS A consecutive cohort of adult spinal deformity patients who underwent corrective surgery with at least 5 levels of instrumentation between January 2008 and December 2012 at a single tertiary spine unit were followed for at least 2 years. Time to death or failure was recorded and cause-specific Cox regressions were applied to evaluate predictors for mechanical failure or death. RESULTS A total of 138 patients with median age of 61 years were included for analysis. Follow up ranged 2.1 to 6.8 years. In total 47% had revision and estimated failure rates were 16% at 1 year increasing to 56% at 5 years. A multivariate analysis adjusting for age at surgery showed increased hazard of failure from LL change > 30°, postoperative TK > 50°, and SS ≤30°. LL change was mostly because of 3-column osteotomy and ending the instrumentation at L5 or S1 increased the hazard of failure more than 6 fold compared with more cranial lumbar levels. CONCLUSION Mechanical failure rate was 47% after adult spinal deformity corrective surgery. LL change > 30°, postoperative TK > 50°, and postoperative SS ≤30° were independent radiographic predictors associated with increased hazard of failure. LEVEL OF EVIDENCE 4.
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Witiw CD, Fessler RG, Nguyen S, Mummaneni P, Anand N, Blaskiewicz D, Uribe J, Wang MY, Kanter AS, Okonkwo D, Park P, Deviren V, Akbarnia BA, Eastlack RK, Shaffrey C, Mundis GM. Re-operation After Long-Segment Fusions for Adult Spinal Deformity: The Impact of Extending the Construct Below the Lumbar Spine. Neurosurgery 2017; 82:211-219. [DOI: 10.1093/neuros/nyx163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 03/12/2017] [Indexed: 11/13/2022] Open
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Riouallon G. Answer to the Letter to the Editor of F. Sanchez-Mariscal et al. concerning "Risk of revision surgery for adult idiopathic scoliosis: a survival analysis of 517 cases over 25 years" by G. Riouallon et al. (Eur Spine J; 2016;25(8):2527-2534). Eur Spine J 2016; 26:279-280. [PMID: 27770333 DOI: 10.1007/s00586-016-4814-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 10/02/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Guillaume Riouallon
- Service de Chirurgie Orthopédique et Traumatologie, Chirurgie du Rachis, Groupe hospitalier Paris Saint-Joseph, 185, rue Raymond Losserand, 75014, Paris, France.
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Sánchez-Mariscal F, Gomez-Rice A, Izquierdo E, Pizones J, Zúñiga L, Álvarez-Gonzalez P. Letter to the Editor concerning "Risk of revision surgery for adult idiopathic scoliosis: a survival analysis of 517 cases over 25 years" by G. Riouallon et al. (Eur Spine J; 2016;25(8):2527-2534). Eur Spine J 2017; 26:278. [PMID: 27734197 DOI: 10.1007/s00586-016-4809-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 10/04/2016] [Indexed: 10/20/2022]
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Hamilton DK, Kanter AS, Bolinger BD, Mundis GM, Nguyen S, Mummaneni PV, Anand N, Fessler RG, Passias PG, Park P, La Marca F, Uribe JS, Wang MY, Akbarnia BA, Shaffrey CI, Okonkwo DO; International Spine Study Group (ISSG). Reoperation rates in minimally invasive, hybrid and open surgical treatment for adult spinal deformity with minimum 2-year follow-up. Eur Spine J 2016; 25:2605-11. [DOI: 10.1007/s00586-016-4443-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 02/05/2016] [Accepted: 02/05/2016] [Indexed: 10/22/2022]
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Mazur MD, Ravindra VM, Schmidt MH, Brodke DS, Lawrence BD, Riva-Cambrin J, Dailey AT. Unplanned reoperation after lumbopelvic fixation with S-2 alar-iliac screws or iliac bolts. J Neurosurg Spine 2015; 23:67-76. [DOI: 10.3171/2014.10.spine14541] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
S-2 alar-iliac (S2AI) screws are an attractive alternative to conventional fixation with iliac bolts because they are lower profile, require less muscle dissection, and have greater pullout strength. Few studies, however, compare outcomes between these techniques.
METHODS
The authors conducted a retrospective cohort study of consecutive adult patients at a single institution from December 2009 to March 2012 who underwent lumbopelvic fixation using S2AI screws or iliac bolts. Medical records were reviewed for patients with clinical failure, defined as an unplanned reoperation because of instrumentation failure and/or wound-related complications. Univariate, multivariate, and survival analyses were used to compare patients who required reoperation with those who did not. Method of pelvic fixation was the main predictor variable of interest, and the authors adjusted for potential confounding risk factors.
RESULTS
Of the 60 patients included, 23 received S2AI screws. Seventeen patients (28%) underwent an osteotomy. The mean follow-up was 22 months. A Kaplan-Meier survival model was used to evaluate the time to reoperation from the initial placement of lumbopelvic instrumentation. The failure-free rate was 96.6% at 6 months, 87.0% at 1 year, and 73.5% at 2 years. Reoperation was more common in patients with iliac bolts than in those with S2AI screws (13 vs 2; p = 0.031). Univariate analysis identified potential risk factors for unplanned reoperation, including use of iliac bolts (p = 0.031), absence of L5–S1 interbody graft (p = 0.048), previous lumbar fusion (p = 0.034), and pathology other than degenerative disease or scoliosis (p = 0.034). After adjusting for other risk factors, multivariate analysis revealed that the use of S2AI screws (OR 8.1 [1.5–73.5]; p = 0.030) was the only independent predictor for preventing unplanned reoperation.
CONCLUSIONS
Both S2AI screws and iliac bolts were effective at improving fusion rates at the lumbosacral junction. The use of S2AI screws, however, was independently associated with fewer unplanned reoperations for wound-related complications and instrumentation failures than the use of iliac bolts.
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Affiliation(s)
| | | | | | - Darrel S. Brodke
- 2Orthopaedics, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Brandon D. Lawrence
- 2Orthopaedics, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
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