1
|
Van Halm-Lutterodt NI, Pan A, Al-Saidi NN, Ye Z, Zhang Y, Zhou L, Yang J, Liu T, Liu Y, Kim SS, Lonner B, Hai Y. Postoperative complications following Schwab-grade-I versus Schwab-grade-II PCO in treating severe rigid kyphoscoliosis patients: comparative matched-group outcomes with minimum 2-year follow-up. Spine J 2023; 23:1908-1919. [PMID: 37619870 DOI: 10.1016/j.spinee.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/09/2022] [Revised: 07/05/2023] [Accepted: 08/13/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND CONTEXT Standard partial facetectomies, (Smith-Petersen Osteotomy, (SPO), (Schwab-grade-I) and complete facet resection also known as Ponte osteotomy, (PO), (Schwab-grade-II) are narrowly akin and collectively appreciated as posterior column shortening osteotomies (PCOs). The former is considered a gentler osteotomy grade than the latter. The spine literature provides very little information on their comparison regarding perioperative complications and major curve correction rate outcomes. PURPOSE To determine whether Schwab-grade-I PCO (SPO) and Schwab-grade-II PCO (PO) are comparably safe in the surgical management of severe rigid scoliosis or kyphoscoliosis patients. STUDY DESIGN/SETTING Retrospective single-center comparative clinical study. PATIENT SAMPLE A total of 38 patients with severe rigid scoliosis or kyphoscoliosis were propensity score matched in this study, (SPO-treated); n=21 (55.30%) and (PO-treated); n=17 (44.70%), who underwent primary spinal deformity corrective surgery, respectively. OUTCOME MEASURES Outcomes included demographics, baseline pulmonary functional outcomes, perioperative complications incidence, hospital costs, Oswestry disability index (ODI), and the Scoliosis Research Society-22 (SRS-22) questionnaire scores. METHODS Following approval by the Institutional Review Board (IRB) of Beijing Chaoyang Hospital-Affiliated Capital Medical University in Beijing, out of a total of 82 consecutive surgical patients with complete data demonstrating severe and/or rigid spinal deformity, a pool of 38 of the 82 (46.3%) propensity-matched adult (≥18 years) patients with severe rigid scoliosis or kyphoscoliosis defined with a preoperative major curve magnitude of ≥80° on anteroposterior plain radiographs, and flexibility of <25% on bending plain radiographs who underwent primary spinal deformity corrective surgery were retrospectively evaluated. The patients were dichotomized into two osteotomy groups: standard (partial) facetectomy (SPO-treated), n=21 with an average age of 24.67 years, (Schwab-grade-I PCO) and complete facet excision, (PO-treated), (ie, Schwab-grade-II PCO), n=17 with an average age of 23.12 years. The minimum follow-up period was 2 years. Primary outcomes included baseline demographics and clinical features. Secondary outcomes included perioperative [intraoperative, immediate, and 2-year postoperative] complication rates. Tertiary outcomes included perioperative ODI and SRS-22 scores. Statistical analyses were carried out by Student t-test and Pearson's Chi-square test (Fisher's Exact Test), through Python statistical software package. Statistical significance was set at (p<.05). RESULTS Of the 38 matched severe rigid scoliosis or kyphoscoliosis patients, 55.30% (n=21) were SPO-treated and 44.70% (n=17) were PO-treated patients, respectively. The overall average age of patients was 23.97 years, with a female incidence of 76.32%. Major curve correction rates were 49.19% and 57.40% in SPO-treated and PO-treated patients, respectively, (p>.05). Immediately following surgery, comparable overall complication rates of 28.57% (n=6/21) versus 29.41% (n=5/17) were observed in the SPO-treated and PO-treated patients, respectively, (p=.726). We observed incidences of 9.52%, (n=2/21) versus 5.88%, (n=1/17) for surgical intensive care unit (SICU) admission, and incidences of 4.76%, (n=1/21) versus 5.88%, (n=1/17) for cardiopulmonary events in SPO-treated versus PO-treated patients following corrective surgery, respectively, (p>.05). The incidences of neurological deficits in the SPO-treated and PO-treated patients were respectively, 14.29%, (n=3/21) versus 17.65%, (n=3/17) immediately following surgery, (p>.05), and 0.00%, (n=0/21) in SPO-treated versus 14.28%, (n=3/21) in PO-treated patients at ≥2 years postoperative, (p<.05). Among the three patients that reported neurological deficits in the PO-treated group at ≥2 years postoperative, two patients had pre-existing baseline neurological deficits. The ODI score in the PO-treated group was significantly inferior at a minimum 2-year follow-up, (p<.05). CONCLUSIONS In the current study, both SPO-treated and PO-treated patients demonstrated statistically comparable surgical complications immediately following corrective surgery. Severe rigid kyphoscoliosis patients with preexisting baseline neurological deficits were more inclined to sustain neurological morbidity following corrective surgery. PCO corrective techniques are warranted as safe options for treating patients with severe rigid spine deformity phenotypes.
Collapse
Affiliation(s)
- Nicholas Ishmael Van Halm-Lutterodt
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China; Department of Orthopedics and Neurosurgery Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Department of Orthopedics Surgery and Neurosurgery, Inspired Spine Health, Burnsville, MN, USA; Department of Healthcare Leadership Program, School of Professional Studies, Brown University, Providence, RI, USA; Department of Orthopedics Surgery, Rhode Island Hospital, Brown University, Providence, RI, USA
| | - Aixing Pan
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Neil Nazar Al-Saidi
- Department of Medicine, Central Michigan University School of Medicine, Mount Pleasant, MI, USA
| | - Ziyang Ye
- Department of Orthopedics Surgery and Neurosurgery, Inspired Spine Health, Burnsville, MN, USA; Department of Business Analytics, University of Chicago, Chicago, IL, USA
| | - Yangpu Zhang
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Lijin Zhou
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jincai Yang
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Tie Liu
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yuzeng Liu
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Sunny Sik Kim
- Department of Orthopedics Surgery and Neurosurgery, Inspired Spine Health, Burnsville, MN, USA
| | - Baron Lonner
- Department of Orthopedics Surgery, The Mount Sinai Hospital, New York City, NY, USA
| | - Yong Hai
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
| |
Collapse
|
2
|
Van Halm-Lutterodt NI, Al-Saidi NN, Mandalia K, Mesregah MK, Ghanem KM, Storlie NR, Huang WH, Chen WC, Bartels-Mensah M, Chen XY, Ye Z, Zhang Y, Pan A, Kim SS, Lonner B, Alanay A, Hai Y. Comparison of Overall Complication Rates in VCR-Based vs Non-VCR-Based Corrective Techniques in Severe Rigid Kyphoscoliosis Patients: A Systematic Review and Meta-Analysis. Global Spine J 2023; 13:1646-1657. [PMID: 36548436 PMCID: PMC10448105 DOI: 10.1177/21925682221146502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVE Compilation of complication outcomes data from the surgical management of severe rigid kyphoscoliosis patients using VCR-based vs non-VCR-based corrective maneuvers is lacking. This meta-analysis aimed to compare complication outcomes between those classified osteotomy approaches. METHODS Thorough literature review and meta-analysis were conducted between January 2000 and September 2021. The selection criteria were studies: i) reporting major curve Cobb angle of ≥80° and flexibility of <25% or 30%; ii) comparing VCR or ≥ Type V Schwab osteotomy defined as VCR-based vs [non-VCR-based] techniques, (any osteotomy or technique other than VCR); iii) published in English with ≥10 patients; iv) reporting complication rates; and v) having minimum of 2-year follow-up. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Significance level was set at (P < .05). RESULTS Of the 174 patients included, 52.30% (n = 91) and 47.70% (n = 83) were VCR-based and non-VCR-based, respectively. The incidence of dural tears/nerve injuries/significant intraoperative-neuromonitoring changes was significantly higher; [OR = 6.78, CI= (1.75 to 26.17), I2 = 0%, (P = .006)] in the VCR-based group than the non-VCR-based group. The 'overall surgical and medical' complication rate was significantly higher in the VCR-based group, [OR = 1.94, CI= (1.02 to 3.67), I2 = 31%, (P = .04)]. CONCLUSION Both VCR-based and non-VCR-based surgical techniques for management of severe rigid scoliosis and kyphoscoliosis patients pose comparable overall surgical complication rates, while a significantly higher perioperative neurological complication incidence was associated with VCR-based technique compared to the non-VCR-based techniques. The VCR-based technique was associated with 6.78 times higher incidence of neurological complications compared to non-VCR-based techniques.
Collapse
Affiliation(s)
- Nicholas Ishmael Van Halm-Lutterodt
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China
- Department of Orthopedics Surgery, Keck Medical Center of University of Southern California, Los Angeles, CA, USA
- Departments of Orthopedic and Neurosurgery, Inspired Spine Health, Burnsville, MN, USA
| | | | | | - Mohamed Kamal Mesregah
- Department of Orthopedic Surgery, Menoufia University Faculty of Medicine, Shebin El-Kom, Egypt
| | | | | | - Wei-Hsun Huang
- Beijing Friendship Hospital Affiliated-Capital Medical University, China
| | - Wei-Cheng Chen
- Beijing Tongren Hospital Affiliated-Capital Medical University, China
| | | | - Xin Yuan Chen
- Department of Arts and Sciences, Concordia University, Montreal, QC, Canada
| | - Ziyang Ye
- Departments of Orthopedic and Neurosurgery, Inspired Spine Health, Burnsville, MN, USA
- Department of Business Analytics, University of Chicago, IL, USA
- Tristate Brain, and Spine Institute, Alexandria, MN, USA
| | - Yangpu Zhang
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, China
| | - Aixing Pan
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, China
| | - Sunny Sik Kim
- Departments of Orthopedic and Neurosurgery, Inspired Spine Health, Burnsville, MN, USA
- Tristate Brain, and Spine Institute, Alexandria, MN, USA
| | - Baron Lonner
- Department of Orthopedics Surgery, The Mount Sinai Hospital, New York, NY, USA
| | - Ahmet Alanay
- Department of Orthopedics and Traumatology, Acibadem Mehmet ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Yong Hai
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, China
| | - International Spinal Deformity Review Study Group (ISDRSG)
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China
- Department of Orthopedics Surgery, Keck Medical Center of University of Southern California, Los Angeles, CA, USA
- Departments of Orthopedic and Neurosurgery, Inspired Spine Health, Burnsville, MN, USA
- Central Michigan University College of Medicine, Mt. Pleasant, MI, USA
- Tufts University School of Medicine, Boston, MA, USA
- Department of Orthopedic Surgery, Menoufia University Faculty of Medicine, Shebin El-Kom, Egypt
- Creighton University School of Medicine, Omaha, NE, USA
- Beijing Friendship Hospital Affiliated-Capital Medical University, China
- Beijing Tongren Hospital Affiliated-Capital Medical University, China
- University of Debrecen School of Medicine, Hungary
- Department of Arts and Sciences, Concordia University, Montreal, QC, Canada
- Department of Business Analytics, University of Chicago, IL, USA
- Tristate Brain, and Spine Institute, Alexandria, MN, USA
- Department of Orthopedics Surgery, The Mount Sinai Hospital, New York, NY, USA
- Department of Orthopedics and Traumatology, Acibadem Mehmet ali Aydinlar University School of Medicine, Istanbul, Turkey
| |
Collapse
|