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Zaidat B, Kurapatti M, Gal JS, Cho SK, Kim JS. Explainable Machine Learning Approach to Prediction of Prolonged Intensive Care Unit Stay in Adult Spinal Deformity Patients: Machine Learning Outperforms Logistic Regression. Global Spine J 2025; 15:1992-2003. [PMID: 39169510 PMCID: PMC11571784 DOI: 10.1177/21925682241277771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2024] Open
Abstract
Study DesignRetrospective cohort study.ObjectivesProlonged ICU stay is a driver of higher costs and inferior outcomes in Adult Spinal Deformity (ASD) patients. Machine learning (ML) models have recently been seen as a viable method of predicting pre-operative risk but are often 'black boxes' that do not fully explain the decision-making process. This study aims to demonstrate ML can achieve similar or greater predictive power as traditional statistical methods and follows traditional clinical decision-making processes.MethodsFive ML models (Decision Tree, Random Forest, Support Vector Classifier, GradBoost, and a CNN) were trained on data collected from a large urban academic center to predict whether prolonged ICU stay would be required post-operatively. 535 patients who underwent posterior fusion or combined fusion for treatment of ASD were included in each model with a 70-20-10 train-test-validation split. Further analysis was performed using Shapley Additive Explanation (SHAP) values to provide insight into each model's decision-making process.ResultsThe model's Area Under the Receiver Operating Curve (AUROC) ranged from 0.67 to 0.83. The Random Forest model achieved the highest score. The model considered length of surgery, complications, and estimated blood loss to be the greatest predictors of prolonged ICU stay based on SHAP values.ConclusionsWe developed a ML model that was able to predict whether prolonged ICU stay was required in ASD patients. Further SHAP analysis demonstrated our model aligned with traditional clinical thinking. Thus, ML models have strong potential to assist with risk stratification and more effective and cost-efficient care.
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Affiliation(s)
- Bashar Zaidat
- Department of Orthopaedics, The Mount Sinai Hospital, New York, NY, USA
| | - Mark Kurapatti
- Department of Orthopaedics, The Mount Sinai Hospital, New York, NY, USA
| | - Jonathan S. Gal
- Department of Orthopaedics, The Mount Sinai Hospital, New York, NY, USA
| | - Samuel K. Cho
- Department of Orthopaedics, The Mount Sinai Hospital, New York, NY, USA
| | - Jun S. Kim
- Department of Orthopaedics, The Mount Sinai Hospital, New York, NY, USA
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Sun X, Huang J, Wang W, Gan L, Cao L, Liu Y, Sun S, Wang J, Lu S. How to view the effectiveness of spinal deformity surgery for adult degenerative scoliosis in octogenarian population? A comprehensive analysis and judgment. Neurosurg Rev 2025; 48:378. [PMID: 40263149 DOI: 10.1007/s10143-025-03525-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2024] [Revised: 03/10/2025] [Accepted: 04/05/2025] [Indexed: 04/24/2025]
Abstract
This study aims to explore the connections between risk factors and clinical outcomes in octogenarian patients diagnosed with adult degenerative scoliosis (ADS). A total of 394 patients participated in this study, with 206 individuals in the younger group and 188 in the octogenarian group. We meticulously gathered patient demographics, including basic information, comorbidities, radiographic data, clinical scoring systems, and details on medical and surgical complications as well as revision surgeries. Univariable linear regression analysis revealed positive correlations between age and several postoperative outcomes: Sagittal vertical axis (SVA) (B = -0.572, P = 0.001), Oswestry Disability Index (ODI) (B = 0.145, P < 0.001), and Japanese Orthopaedic Association (JOA) score (B = 0.035, P < 0.001). Additionally, a positive relationship was observed between age and both proximal junctional kyphosis (PJK) (B = 0.055, P = 0.039) and internal fixation loosening (B = 0.253, P < 0.001). Receiver operator characteristic (ROC) curve analysis indicated that the age threshold values for predicting PJK and internal fixation loosening were 71.5 and 79.5, respectively. In octogenarian patients with ADS, the cost associated with spinal deformity surgery is accompanied by a greater incidence of surgical complications. Compared to younger patients, surgical intervention tends to be more effective at enhancing objective motor functions while having a lesser impact on the subjective experiences of octogenarian patients.
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Affiliation(s)
- Xiangyao Sun
- Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Beijing, 100053, China.
- National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China.
- Beijing Glitzern Technology Co.,Ltd, Beijing, 100077, China.
| | - Jiang Huang
- Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Beijing, 100053, China
- National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China
| | - Weiliang Wang
- Department of Traumatology, Beijing Daxing District People's Hospital, Beijing, 102600, China
| | - Limeng Gan
- Department of Orthopaedics, Beijing Daxing District People's Hospital, Beijing, 102600, China
| | - Li Cao
- Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Beijing, 100053, China
- National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China
| | - Yuqi Liu
- Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Siyuan Sun
- Department of Interdisciplinary, Life Science, Purdue University, West Lafayette, IN, 47907, USA
| | - Juyong Wang
- Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Beijing, 100053, China
- National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China
| | - Shibao Lu
- Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Beijing, 100053, China.
- National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China.
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Yeh C, Hsiao PH, Chen MJW, Lo YS, Tseng C, Lin CY, Li LY, Lai CY, Chang CC, Chen HT. Outcome and complication following single-staged posterior minimally invasive surgery in adult spinal deformity. BMC Musculoskelet Disord 2025; 26:318. [PMID: 40175972 PMCID: PMC11963671 DOI: 10.1186/s12891-025-08550-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2024] [Accepted: 03/18/2025] [Indexed: 04/04/2025] Open
Abstract
BACKGROUND The aging population is experiencing a rising incidence of musculoskeletal problems and degenerative spinal deformities. Adult spinal deformity (ASD) presents challenges, with associated risks in open surgery. Minimally invasive surgery (MIS) is becoming increasingly popular due to its positive outcomes and potential benefits. This study aims to explore the clinical outcome and complications of posterior approach MIS in patients with ASD. METHODS We conducted a retrospective analysis of patients with adult spinal deformity who underwent posterior minimally invasive surgery. 46 patients meeting the criteria were identified between June 2017 and September 2023. Comprehensive data were collected, including demographic details, surgical information, full-length radiographic measurements, and visual analog scale (VAS) pain scores. These data were obtained preoperatively, postoperatively, and at the final follow-up. RESULTS A total of 46 patients were included in the study, with a mean age of 68.58 years and a minimum follow-up period of 6 months. The mean operative time was 327 min, and the mean blood loss was 307 ml. Preoperative radiographic measurements were as follows: Coronal Cobb angle, 18.60 ± 11.35°; lumbar lordosis (LL), 22.79 ± 21.87°; pelvic incidence (PI), 53.05 ± 14.13°; PI-LL mismatch, 30.26 ± 23.48°; pelvic tilt (PT), 32.53 ± 10.38°; T1 pelvic angle (TPA), 31.91 ± 12.39°; and sagittal vertical axis (SVA), 77.77 ± 60.47 mm. At the final follow-up, coronal Cobb angle was 10.08 ± 6.47° (P <0.0001), LL was 26.16 ± 16.92° (P = 0.4293), PI was 54.17 ± 12.13° (P = 0.6965), PI-LL mismatch was 28.00 ± 17.03° (P = 0.6144), PT was 27.74 ± 10.24° (P = 0.0345), TPA was 25.10 ± 10.95 (P = 0.0090) and SVA was 47.91 ± 46.94 mm (P = 0.0129). Functional outcomes improved as well, with the mean Oswestry Disability Index (ODI) decreasing from 34.9 to 23.6 and the Visual Analog Scale (VAS) score for back pain reducing from 8.4 to 3.4. Surgical complications occurred in 39.1% of cases, with a low reoperation rate of 4.3%. CONCLUSION Single-staged posterior MIS effectively corrects global alignment in adult spinal deformities, satisfying patient demand and yielding positive clinical outcome with low re-operation rate.
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Affiliation(s)
- Chun Yeh
- Department of Education, China Medical University Hospital, China Medical University, Taichung, 404, Taiwan
| | - Pang-Hsuan Hsiao
- Department of Orthopaedic Surgery, China Medical University Hospital, China Medical University, Taichung, 404, Taiwan
- Spine Center, China Medical University Hospital, China Medical University, Taichung, 404, Taiwan
| | - Michael Jian-Wen Chen
- Department of Orthopaedic Surgery, China Medical University Hospital, China Medical University, Taichung, 404, Taiwan
- Spine Center, China Medical University Hospital, China Medical University, Taichung, 404, Taiwan
| | - Yuan-Shun Lo
- Department of Orthopaedic Surgery, China Medical University Hospital, China Medical University, Taichung, 404, Taiwan
- Spine Center, China Medical University Hospital, China Medical University, Taichung, 404, Taiwan
- Department of Orthopedic Surgery, China Medical University Beigang Hospital, China Medical University, Yunlin County, 651, Taiwan
| | - Chun Tseng
- Department of Orthopaedic Surgery, China Medical University Hospital, China Medical University, Taichung, 404, Taiwan
- Spine Center, China Medical University Hospital, China Medical University, Taichung, 404, Taiwan
- Department of Orthopedic Surgery, China Medical University Beigang Hospital, China Medical University, Yunlin County, 651, Taiwan
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, 404, Taiwan
| | - Chia-Yu Lin
- Department of Orthopaedic Surgery, China Medical University Hospital, China Medical University, Taichung, 404, Taiwan
- Spine Center, China Medical University Hospital, China Medical University, Taichung, 404, Taiwan
| | - Ling-Yi Li
- Department of Orthopaedic Surgery, China Medical University Hospital, China Medical University, Taichung, 404, Taiwan
- Spine Center, China Medical University Hospital, China Medical University, Taichung, 404, Taiwan
| | - Chien-Ying Lai
- Department of Orthopaedic Surgery, China Medical University Hospital, China Medical University, Taichung, 404, Taiwan
- Spine Center, China Medical University Hospital, China Medical University, Taichung, 404, Taiwan
| | - Chien-Chun Chang
- Minimally Invasive Spine and Joint Center, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
- Department of Leisure Industry Management, National Chin-Yi University of Technology, Taichung, Taiwan
- Department of Orthopaedic, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
| | - Hsien-Te Chen
- Department of Orthopaedic Surgery, China Medical University Hospital, China Medical University, Taichung, 404, Taiwan.
- Spine Center, China Medical University Hospital, China Medical University, Taichung, 404, Taiwan.
- Department of Sport Medicine, College of Health Care, China Medical University, Taichung, 404, Taiwan.
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Lafage R, Kim HJ, Eastlack RK, Daniels AH, Diebo BG, Mundis G, Khalifé M, Smith JS, Bess SR, Shaffrey CI, Ames CP, Burton DC, Gupta MC, Klineberg EO, Schwab FJ, Lafage V. Revision Strategy for Proximal Junctional Failure: Combined Effect of Proximal Extension and Focal Correction. Global Spine J 2025; 15:1644-1652. [PMID: 38736317 PMCID: PMC11571888 DOI: 10.1177/21925682241254805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/14/2024] Open
Abstract
Study designRetrospective review of a prospectively-collected multicenter database.ObjectivesThe objective of this study was to determine optimal strategies in terms of focal angular correction and length of proximal extension during revision for PJF.Methods134 patients requiring proximal extension for PJF were analyzed in this study. The correlation between amount of proximal junctional angle (PJA) reduction and recurrence of proximal junctional kyphosis (PJK) and/or PJF was investigated. Following stratification by the degree of PJK correction and the numbers of levels extended proximally, rates of radiographic PJK (PJA >28° & ΔPJA >22°), and recurrent surgery for PJF were reported.ResultsBefore revision, mean PJA was 27.6° ± 14.6°. Mean number of levels extended was 6.0 ± 3.3. Average PJA reduction was 18.8° ± 18.9°. A correlation between the degree of PJA reduction and rate of recurrent PJK was observed (r = -.222). Recurrent radiographic PJK (0%) and clinical PJF (4.5%) were rare in patients undergoing extension ≥8 levels, regardless of angular correction. Patients with small reductions (<5°) and small extensions (<4 levels) experienced moderate rates of recurrent PJK (19.1%) and PJF (9.5%). Patients with large reductions (>30°) and extensions <8 levels had the highest rate of recurrent PJK (31.8%) and PJF (16.0%).ConclusionWhile the degree of focal PJK correction must be determined by the treating surgeon based upon clinical goals, recurrent PJK may be minimized by limiting reduction to <30°. If larger PJA correction is required, more extensive proximal fusion constructs may mitigate recurrent PJK/PJF rates.
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Affiliation(s)
- Renaud Lafage
- Department of Orthopedic Surgery, Northwell Health, Lenox Hill Hospital, New York, NY, USA
| | - Han-Jo Kim
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Robert K. Eastlack
- Department of Orthopedic Surgery, Scripps Clinic Torrey Pines, La Jolla, CA, USA
| | - Alan H. Daniels
- Department of Orthopaedic Surgery, University Orthopedics, Providence, RI, USA
| | - Bassel G. Diebo
- Department of Orthopaedic Surgery, University Orthopedics, Providence, RI, USA
| | - Greg Mundis
- San Diego Spine Foundation, San Diego, CA, USA
| | - Marc Khalifé
- Department of Orthopedic Surgery, Northwell Health, Lenox Hill Hospital, New York, NY, USA
- Department of Orthopedic Surgery, Hôpital Européen Georges Pompidou, Paris, France
| | - Justin S. Smith
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA
| | - Shay R. Bess
- Department of Orthopaedic Surgery, Denver International Spine Center, Denver, CO, USA
| | | | - Christopher P. Ames
- Department of Neurosurgery, University of California San Francisco Spine Center, San Francisco, CA, USA
| | - Douglas C. Burton
- Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Munish C. Gupta
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Eric O. Klineberg
- Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, CA, USA
| | - Frank J. Schwab
- Department of Orthopedic Surgery, Northwell Health, Lenox Hill Hospital, New York, NY, USA
| | - Virginie Lafage
- Department of Orthopedic Surgery, Northwell Health, Lenox Hill Hospital, New York, NY, USA
| | - ISSG
- International Spine Study Group, Denver, CO, USA
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Olson J, Mo KC, Schmerler J, Harris AB, Lee JS, Skolasky RL, Kebaish KM, Neuman BJ. AM-PAC Mobility Score <13 Predicts Development of Ileus Following Adult Spinal Deformity Surgery. Clin Spine Surg 2024; 37:E348-E353. [PMID: 38490976 DOI: 10.1097/bsd.0000000000001599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 01/22/2024] [Indexed: 03/18/2024]
Abstract
STUDY DESIGN Retrospective review. OBJECTIVE To determine whether the Activity Measure for Post-Acute Care (AM-PAC) "6-Clicks" score is associated with the development of postoperative ileus. SUMMARY OF BACKGROUND DATA Adult spinal deformity (ASD) surgery has a high complication rate. One common complication is postoperative ileus, and poor postoperative mobility has been implicated as a modifiable risk factor for this condition. METHODS Eighty-five ASD surgeries in which ≥5 levels were fused were identified in a single institution database. A physical therapist/physiatrist collected patients' daily postoperative AM-PAC scores, for which we assessed first, last, and daily changes. We used multivariable linear regression to determine the marginal effect of ileus on continuous AM-PAC scores; threshold linear regression with Bayesian information criterion to identify a threshold AM-PAC score associated with ileus; and multivariable logistic regression to determine the utility of the score thresholds when controlling for confounding variables. RESULTS Ten of 85 patients (12%) developed ileus. The mean day of developing ileus was postoperative day 3.3±2.35. The mean first and last AM-PAC scores were 16 and 18, respectively. On bivariate analysis, the mean first AM-PAC score was lower in patients with ileus than in those without (13 vs. 16; P< 0.01). Ileus was associated with a first AM-PAC score of 3 points lower (Coef. -2.96; P< 0.01) than that of patients without ileus. Patients with an AM-PAC score<13 had 8 times greater odds of developing ileus ( P= 0.023). Neither the last AM-PAC score nor the daily change in AM-PAC score was associated with ileus. CONCLUSIONS In our institutional cohort, a first AM-PAC score of <13, corresponding to an inability to walk or stand for more than 1 minute, was associated with the development of ileus. Early identification of patients who cannot walk or stand after surgery can help determine which patients would benefit from prophylactic management. LEVEL OF EVIDENCE Level-III.
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Affiliation(s)
- Jarod Olson
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
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Olson J, Mo KC, Schmerler J, Durand WM, Kebaish KM, Skolasky RL, Neuman BJ. Impact of Controlled Versus Uncontrolled mFI-5 Frailty on Perioperative Complications After Adult Spinal Deformity Surgery. Clin Spine Surg 2024; 37:340-345. [PMID: 38531820 DOI: 10.1097/bsd.0000000000001595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 01/22/2024] [Indexed: 03/28/2024]
Abstract
STUDY DESIGN Retrospective review. OBJECTIVES We substratified the mFI-5 frailty index to reflect controlled and uncontrolled conditions and assess their relationship to perioperative complications. SUMMARY OF BACKGROUND DATA Risk assessment before adult spinal deformity (ASD) surgery is critical because the surgery is highly invasive with a high complication rate. Although frailty is associated with risk of surgical complications, current frailty measures do not differentiate between controlled and uncontrolled conditions. METHODS Frailty was calculated using the mFI-5 index for 170 ASD patients with fusion of ≥5 levels. Uncontrolled frailty was defined as blood pressure >140/90 mm Hg, HbA1C >7% or postprandial glucose >180 mg/dL, or recent chronic obstructive pulmonary disease (COPD) exacerbation, while on medication. Patients were divided into nonfrailty, controlled frailty, and uncontrolled frailty cohorts. The primary outcome measure was perioperative major and wound complications. Bivariate analysis was performed. Multivariable analysis assessed the relationship between frailty and perioperative complications. RESULTS The cohorts included 97 nonfrail, 54 controlled frail, and 19 uncontrolled frail patients. Compared with nonfrail patients, patients with uncontrolled frailty were more likely to have age older than 60 years (84% vs. 24%), hyperlipidemia (42% vs. 20%), and Oswestry Disability Index (ODI) score >42 (84% vs. 52%) ( P <0.05 for all). Controlled frailty was associated with those older than 60 years (41% vs. 24%) and hyperlipidemia (52% vs. 20%) ( P <0.05 for all). On multivariable regression analysis controlling for hyperlipidemia, functional independence, motor weakness, ODI>42, and age older than 60 years, patients with uncontrolled frailty had greater odds of major complications (OR 4.24, P =0.03) and wound complications (OR 9.47, P =0.046) compared with nonfrail patients. Controlled frailty was not associated with increased risk of perioperative complications ( P >0.05 for all). CONCLUSIONS Although patients with uncontrolled frailty had higher risk of perioperative complications compared with nonfrail patients, patients with controlled frailty did not, suggesting the importance of controlling modifiable risk factors before surgery. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Jarod Olson
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
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Tsutsui S, Hashizume H, Iwasaki H, Takami M, Ishimoto Y, Nagata K, Yamada H. Long-term Outcomes After Adult Spinal Deformity Surgery Using Lateral Interbody Fusion: Short Versus Long Fusion. Clin Spine Surg 2024; 37:E371-E376. [PMID: 38366331 DOI: 10.1097/bsd.0000000000001583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 01/22/2024] [Indexed: 02/18/2024]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To investigate long-term outcomes after short or long fusion for adult spinal deformity using lateral interbody fusion. SUMMARY OF BACKGROUND DATA Lateral interbody fusion is commonly used in adult spinal deformity surgery. Favorable short-term outcomes have been reported, but not long-term outcomes. Lateral interbody fusion with strong ability to correct deformity may allow the selection of short fusion techniques. MATERIALS AND METHODS We retrospectively reviewed adults who underwent this surgery with a minimum of 5 years of follow-up. Short fusion with the uppermost instrumented vertebra in the lumbar spine was performed in patients without degenerative changes at the thoracolumbar junction (S-group); others underwent long fusion with the uppermost instrumented vertebra in the thoracic spine (L-group). We assessed radiographic and clinical outcomes. RESULTS Short fusion was performed in 29 of 54 patients. One patient per group required revision surgery. Of the remainder, with similar preoperative characteristics and deformity correction between groups, correction loss (pelvic incidence-lumbar lordosis, P =0.003; pelvic tilt, P =0.005; sagittal vertical axis, P ˂0.001) occurred within 2 years postoperatively in the S-group, and sagittal vertical axis continued to increase until the 5-year follow-up ( P =0.021). Although there was a significant change in Oswestry disability index in the S-group ( P =0.031) and self-image of Scoliosis Research Society 22r score in both groups ( P =0.045 and 0.02) from 2- to 5-year follow-up, minimum clinically important differences were not reached. At 5-year follow-up, there was a significant difference in Oswestry Disability Index ( P =0.013) and Scoliosis Research Society 22r scores (function: P =0.028; pain: P =0.003; subtotal: P =0.006) between the groups, but satisfaction scores were comparable and Oswestry Disability Index score (29.8%) in the S-group indicated moderate disability. CONCLUSIONS Health-related quality of life was maintained between 2- and 5-year follow-up in both groups. Short fusion may be an option for patients without degenerative changes at the thoracolumbar junction. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Shunji Tsutsui
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
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Tsutsui S, Hashizume H, Iwasaki H, Takami M, Ishimoto Y, Nagata K, Teraguchi M, Yamada H. Willingness to undergo the same surgery again among older patients who have undergone corrective fusion surgery for adult spinal deformity. J Clin Neurosci 2024; 127:110761. [PMID: 39059335 DOI: 10.1016/j.jocn.2024.110761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 07/14/2024] [Accepted: 07/19/2024] [Indexed: 07/28/2024]
Abstract
Despite less invasive surgical procedures in adult spinal deformity (ASD) surgery, some older patients have complications and long recovery time. We investigated patients' willingness to undergo the same surgery again and sought to elucidate the factors related to their perception of surgical outcomes. Enrolled were 60 of our patients (≥65 years old) that underwent long corrective fusion using lateral interbody fusion and who had a minimum of 2 years of follow-up. Patients were asked whether they would theoretically undergo the same surgery again: 28 answered yes (46.7 %; Group-Y), and 32 answered no (53.3 %; Group-N). There was no difference between the groups in age, sex, body mass index, frailty, preoperative patient-reported outcomes (PROs; Oswestry disability index [ODI] and Scoliosis Research Society 22r [SRS-22r]), surgical time, estimated blood loss, or pre-operative and 2-year post-operative radiographic parameters. Major complications had occurred more frequently in Group-N (P = 0.048). Although at 2-year follow-up there was significant improvement of spinal deformity and PROs (P < 0.001) in both groups, PROs in Group-N were inferior (Visual analogue scale [VAS] for low back pain, P = 0.043; VAS for satisfaction, P = 0.001; ODI: P = 0.005; SRS-22r: pain, P = 0.032; self-image, P = 0.014; subtotal, P = 0.005; satisfaction, P < 0.001). After multivariate logistic regression analysis with the willingness to undergo the same surgery again as an objective factor, incidence of major complication was found to be an independently-associated factor in unwillingness to undergo the same surgery again for older patients with ASD if they had the same condition in the future. Avoiding major perioperative complications is important in obtaining satisfactory perception of outcomes in ASD surgery.
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Affiliation(s)
- Shunji Tsutsui
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8510, Japan.
| | - Hiroshi Hashizume
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8510, Japan
| | - Hiroshi Iwasaki
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8510, Japan
| | - Masanari Takami
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8510, Japan
| | - Yuyu Ishimoto
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8510, Japan
| | - Keiji Nagata
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8510, Japan
| | - Masatoshi Teraguchi
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8510, Japan
| | - Hiroshi Yamada
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8510, Japan
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Kazarian GS, Feuchtbaum E, Bao H, Soroceanu A, Kelly MP, Kebaish KM, Shaffrey CI, Burton DC, Ames CP, Mundis GM, Bess S, Klineberg EO, Swamy G, Schwab FJ, Kim HJ. A comparative cohort study of surgical approaches for adult spinal deformity at a minimum 2-year follow-up. 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 2024:10.1007/s00586-024-08354-y. [PMID: 38955866 DOI: 10.1007/s00586-024-08354-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 05/30/2024] [Accepted: 06/02/2024] [Indexed: 07/04/2024]
Abstract
STUDY DESIGN This study was a retrospective multi-center comparative cohort study. MATERIALS AND METHODS A retrospective institutional database of operative adult spinal deformity patients was utilized. All fusions > 5 vertebral levels and including the sacrum/pelvis were eligible for inclusion. Revisions, 3 column osteotomies, and patients with < 2-year clinical follow-up were excluded. Patients were separated into 3 groups based on surgical approach: 1) posterior spinal fusion without interbody (PSF), 2) PSF with interbody (PSF-IB), and 3) anteroposterior (AP) fusion (anterior lumbar interbody fusion or lateral lumbar interbody fusion with posterior screw fixation). Intraoperative, radiographic, and clinical outcomes, as well as complications, were compared between groups with ANOVA and χ2 tests. RESULTS One-hundred and thirty-eight patients were included for study (PSF, n = 37; PSF-IB, n = 44; AP, n = 57). Intraoperatively, estimated blood loss was similar between groups (p = 0.171). However, the AP group had longer operative times (547.5 min) compared to PSF (385.1) and PSF-IB (370.7) (p < 0.001). Additionally, fusion length was shorter in PSF-IB (11.4) compared to AP (13.6) and PSF (12.9) (p = 0.004). There were no differences between the groups in terms of change in alignment from preoperative to 2 years postoperative. There were no differences in clinical outcomes. While postoperative complications were largely similar between groups, operative complications were higher in the AP group (31.6%) compared to the PSF (5.4%) and PSF-IB (9.1) groups (p < 0.001). CONCLUSION While there were differences in intraoperative outcomes (operative time and fusion length), there were no differences in postoperative clinical or radiographic outcomes. AP fusion was associated with a higher rate of operative complications.
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Affiliation(s)
- Gregory S Kazarian
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - Eric Feuchtbaum
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - Hongda Bao
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - Alex Soroceanu
- Orthopaedic Surgery, University of Calgary, Calgary, Canada
| | - Michael P Kelly
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
- Rady Children's Hospital, San Diego, USA
| | - Khaled M Kebaish
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
- Johns Hopkins, Baltimore, USA
| | - Christopher I Shaffrey
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
- Duke Health, Durham, USA
| | - Douglas C Burton
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
- University of Kansas Medical Center, Kansas City, USA
| | - Christopher P Ames
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
- UCSF Health, San Francisco, USA
| | - Gregory M Mundis
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
- San Diego Spine, San Diego, USA
| | - Shay Bess
- Denver International Spine Center, Denver, CO, USA
| | - Eric O Klineberg
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
- Orthopaedic Surgery, UTHealth Houston, Houston, USA
| | - Ganesh Swamy
- Orthopaedic Surgery, University of Calgary, Calgary, Canada
| | - Frank J Schwab
- Orthoapedic Surgery, Northwell Health, New York City, USA
| | - Han Jo Kim
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA.
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Ozer AF, Akgun MY, Ucar EA, Hekimoglu M, Basak AT, Gunerbuyuk C, Toklu S, Oktenoglu T, Sasani M, Akgul T, Ates O. Can Dynamic Spinal Stabilization Be an Alternative to Fusion Surgery in Adult Spinal Deformity Cases? Int J Spine Surg 2024; 18:152-163. [PMID: 38561203 PMCID: PMC11287803 DOI: 10.14444/8588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Rigid stabilization and fusion surgery are widely used for the correction of spinal sagittal and coronal imbalance (SCI). However, instrument failure, pseudoarthrosis, and adjacent segment disease are frequent complications of rigid stabilization and fusion surgery in elderly patients. In this study, we present the results of dynamic stabilization and 2-stage dynamic stabilization surgery for the treatment of spinal SCI. The advantages and disadvantages are discussed, especially as an alternative to fusion surgery. METHODS In our study, spinal, sagittal, and coronal deformities were corrected with dynamic stabilization performed in a single session in patients with good bone quality (without osteopenia and osteoporosis), while 2-stage surgery was performed in patients with poor bone quality (first stage: percutaneous placement of screws; second stage: placement of dynamic rods and correction of spinal SCI 4-6 months after the first stage). One-stage dynamic spinal instrumentation was applied to 20 of 25 patients with spinal SCI, and 2-stage dynamic spinal instrumentation was applied to the remaining 5 patients. RESULTS Spinal SCI was corrected with these stabilization systems. At 2-year follow-up, no significant loss was observed in the instrumentation system, while no significant loss of correction was observed in sagittal and coronal deformities. CONCLUSION In adult patients with spinal SCI, single or 2-stage dynamic stabilization is a viable alternative to fusion surgery due to the very low rate of instrument failure. CLINICAL RELEVANCE This study questions the use of dynamic stabilization systems for the treatment of adult degenerative deformities. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Ali Fahir Ozer
- Department of Neurosurgery, Koc University Hospital, Istanbul, Turkey
- Spine Center, Koc University Hospital, Istanbul, Turkey
- Bioengineering and Orthopaedic Surgery Colleges of Engineering and Medicine, University of Toledo, Toledo, OH, USA
| | - Mehmet Yigit Akgun
- Department of Neurosurgery, Koc University Hospital, Istanbul, Turkey
- Spine Center, Koc University Hospital, Istanbul, Turkey
| | - Ege Anil Ucar
- Faculty of Medicine, Koc University, Istanbul, Turkey
| | - Mehdi Hekimoglu
- Department of Neurosurgery, American Hospital, Istanbul, Turkey
| | | | | | - Sureyya Toklu
- Department of Neurosurgery, Erzurum Bolge Research and Education Hospital, Erzurum, Turkey
| | - Tunc Oktenoglu
- Department of Neurosurgery, Koc University Hospital, Istanbul, Turkey
- Spine Center, Koc University Hospital, Istanbul, Turkey
| | - Mehdi Sasani
- Department of Neurosurgery, Koc University Hospital, Istanbul, Turkey
- Spine Center, Koc University Hospital, Istanbul, Turkey
| | - Turgut Akgul
- Spine Center, Koc University Hospital, Istanbul, Turkey
| | - Ozkan Ates
- Department of Neurosurgery, Koc University Hospital, Istanbul, Turkey
- Spine Center, Koc University Hospital, Istanbul, Turkey
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11
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Passias PG, Pierce KE, Mir JM, Krol O, Lafage R, Lafage V, Line B, Uribe JS, Hostin R, Daniels A, Hart R, Burton D, Shaffrey C, Schwab F, Diebo BG, Ames CP, Smith JS, Schoenfeld AJ, Bess S, Klineberg EO. Development of a modified frailty index for adult spinal deformities independent of functional changes following surgical correction: a true baseline risk assessment tool. Spine Deform 2024; 12:811-817. [PMID: 38305990 DOI: 10.1007/s43390-023-00808-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 12/16/2023] [Indexed: 02/03/2024]
Abstract
PURPOSE To develop a simplified, modified frailty index for adult spinal deformity (ASD) patients dependent on objective clinical factors. METHODS ASD patients with baseline (BL) and 2-year (2Y) follow-up were included. Factors with the largest R2 value derived from multivariate forward stepwise regression were including in the modified ASD-FI (clin-ASD-FI). Factors included in the clin-ASD-FI were regressed against mortality, extended length of hospital stay (LOS, > 8 days), revisions, major complications and weights for the clin-ASD-FI were calculated via Beta/Sullivan. Total clin-ASD-FI score was created with a score from 0 to 1. Linear regression correlated clin-ASD-FI with ASD-FI scores and published cutoffs for the ASD-FI were used to create the new frailty cutoffs: not frail (NF: < 0.11), frail (F: 0.11-0.21) and severely frail (SF: > 0.21). Binary logistic regression assessed odds of complication or reop for frail patients. RESULTS Five hundred thirty-one ASD patients (59.5 yrs, 79.5% F) were included. The final model had a R2 of 0.681, and significant factors were: < 18.5 or > 30 BMI (weight: 0.0625 out of 1), cardiac disease (0.125), disability employment status (0.3125), diabetes mellitus (0.0625), hypertension (0.0625), osteoporosis (0.125), blood clot (0.1875), and bowel incontinence (0.0625). These factors calculated the score from 0 to 1, with a mean cohort score of 0.13 ± 0.14. Breakdown by clin-ASD-FI score: 51.8% NF, 28.1% F, 20.2% SF. Increasing frailty severity was associated with longer LOS (NF: 7.0, F: 8.3, SF: 9.2 days; P < 0.001). Frailty independently predicted occurrence of any complication (OR: 9.357 [2.20-39.76], P = 0.002) and reop (OR: 2.79 [0.662-11.72], P = 0.162). CONCLUSIONS Utilizing an existing ASD frailty index, we proposed a modified version eliminating the patient-reported components. This index is a true assessment of physiologic status, and represents a superior risk factor assessment compared to other tools for both primary and revision spinal deformity surgery as a result of its immutability with surgery, lack of subjectivity, and ease of use.
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Affiliation(s)
- Peter G Passias
- Division of Spinal Surgery, Departments of Orthopaedic and Neurological Surgery, NYU Langone Medical Center, Orthopaedic Hospital - NYU School of Medicine, New York Spine Institute, 301 East 17th St, New York, NY, 10003, USA.
| | - Katherine E Pierce
- Division of Spinal Surgery, Departments of Orthopaedic and Neurological Surgery, NYU Langone Medical Center, Orthopaedic Hospital - NYU School of Medicine, New York Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Jamshaid M Mir
- Division of Spinal Surgery, Departments of Orthopaedic and Neurological Surgery, NYU Langone Medical Center, Orthopaedic Hospital - NYU School of Medicine, New York Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Oscar Krol
- Division of Spinal Surgery, Departments of Orthopaedic and Neurological Surgery, NYU Langone Medical Center, Orthopaedic Hospital - NYU School of Medicine, New York Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Renaud Lafage
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Virginie Lafage
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Breton Line
- Department of Spine Surgery, Denver International Spine Clinic, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, CO, USA
| | - Juan S Uribe
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Richard Hostin
- Department of Orthopaedic Surgery, Baylor Scoliosis Center, Dallas, TX, USA
| | - Alan Daniels
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Robert Hart
- Department of Orthopaedic Surgery, Swedish Neuroscience Institute, Seattle, WA, USA
| | - Douglas Burton
- Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Frank Schwab
- Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA
| | - Bassel G Diebo
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Christopher P Ames
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA
| | - Andrew J Schoenfeld
- Department of Orthopedic Surgery, Brigham and Women's Center for Surgery and Public Health, Boston, MA, USA
| | - Shay Bess
- Department of Spine Surgery, Denver International Spine Clinic, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, CO, USA
| | - Eric O Klineberg
- Department of Orthopaedic Surgery, University of California, Davis, Davis, CA, USA
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12
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Passias PG, Pierce KE, Dave P, Lafage R, Lafage V, Schoenfeld AJ, Line B, Uribe J, Hostin R, Daniels A, Hart R, Burton D, Kim HJ, Mundis GM, Eastlack R, Diebo BG, Gum JL, Shaffrey C, Schwab F, Ames CP, Smith JS, Bess S, Klineberg E, Gupta MC, Hamilton DK. When not to Operate in Spinal Deformity: Identifying Subsets of Patients With Simultaneous Clinical Deterioration, Major Complications, and Reoperation. Spine (Phila Pa 1976) 2023; 48:1481-1485. [PMID: 37470375 DOI: 10.1097/brs.0000000000004778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 06/15/2023] [Indexed: 07/21/2023]
Abstract
STUDY DESIGN Retrospective review of a prospectively enrolled adult spinal deformity (ASD) database. OBJECTIVE To investigate what patient factors elevate the risk of sub-optimal outcomes after deformity correction. BACKGROUND Currently, it is unknown what factors predict a poor outcome after adult spinal deformity surgery, which may require increased preoperative consideration and counseling. MATERIALS AND METHODS Patients >18 yrs undergoing surgery for ASD(scoliosis≥20°, SVA≥5 cm, PT≥25°, or TK≥60°). An unsatisfactory outcome was defined by the following categories met at two years: (1) clinical: deteriorating in ODI at two years follow-up (2) complications/reoperation: having a reoperation and major complication were deemed high risk for poor outcomes postoperatively (HR). Multivariate analyses assessed predictive factors of HR patients in adult spinal deformity patients. RESULTS In all, 633 adult spinal deformity (59.9 yrs, 79% F, 27.7 kg/m 2, CCI: 1.74) were included. Baseline severe Schwab modifier incidence (++): 39.2% pelvic incidence and lumbar lordosis, 28.8% sagittal vertical axis, 28.9% PT. Overall, 15.5% of patients deteriorated in ODI by two years, while 7.6% underwent reoperation and had a major complication. This categorized 11 (1.7%) as HR. HR were more comorbid in terms of arthritis (73%), heart disease (36%), and kidney disease (18%), P <0.001. Surgically, HR had greater EBL (4431ccs) and underwent more osteotomies (91%), specifically Ponte(36%) and Three Column Osteotomies(55%), which occurred more at L2(91%). HR underwent more PLIFs (45%) and had more blood transfusion units (2641ccs), all P <0.050. The multivariate regression determined a combination of a baseline Distress and Risk Assessment Method score in the 75th percentile, having arthritis and kidney disease, a baseline right lower extremity motor score ≤3, cSVA >65 mm, C2 slope >30.2°, CTPA >5.5° for an R2 value of 0.535 ( P <0.001). CONCLUSIONS When addressing adult spine deformities, poor outcomes tend to occur in severely comorbid patients with major baseline psychological distress scores, poor neurologic function, and concomitant cervical malalignment.
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Affiliation(s)
- Peter G Passias
- Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, New York, NY
| | - Katherine E Pierce
- Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, New York, NY
| | - Pooja Dave
- Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, New York, NY
| | - Renaud Lafage
- Department of Orthopedics, Hospital for Special Surgery, New York, NY
| | - Virginie Lafage
- Department of Orthopedics, Hospital for Special Surgery, New York, NY
| | - Andrew J Schoenfeld
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Breton Line
- Department of Spine Surgery, Denver International Spine Clinic, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, CO
| | - Juan Uribe
- Department of Neurosurgery, University of South Florida, Tampa, FL
| | - Richard Hostin
- Department of Orthopaedic Surgery, Baylor Scoliosis Center, Dallas, TX
| | - Alan Daniels
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI
| | - Robert Hart
- Department of Orthopaedic Surgery, Swedish Neuroscience Institute, Seattle, WA
| | - Douglas Burton
- Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Han Jo Kim
- Department of Orthopedics, Hospital for Special Surgery, New York, NY
| | | | - Robert Eastlack
- Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA
| | - Bassel G Diebo
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI
| | - Jeffrey L Gum
- Department of Orthopaedic Surgery, Norton Leatherman Spine Center, Louisville, KY
| | - Christopher Shaffrey
- Departments of Neurosurgery and Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| | - Frank Schwab
- Department of Orthopedics, Hospital for Special Surgery, New York, NY
| | - Christopher P Ames
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia, Charlottesville, VA
| | - Shay Bess
- Department of Spine Surgery, Denver International Spine Clinic, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, CO
| | - Eric Klineberg
- Department of Orthopaedic Surgery, University of California, Davis, Davis, CA
| | - Munish C Gupta
- Department of Orthopaedic Surgery, Washington University of St Louis, St. Louis, MO
| | - D Kojo Hamilton
- Departments of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA
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Dalton J, Mohamed A, Akioyamen N, Schwab FJ, Lafage V. PreOperative Planning for Adult Spinal Deformity Goals: Level Selection and Alignment Goals. Neurosurg Clin N Am 2023; 34:527-536. [PMID: 37718099 DOI: 10.1016/j.nec.2023.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Adult Spinal Deformity (ASD) is a complex pathologic condition with significant impact on quality of life, including pain, loss of function, and fatigue. Achieving realignment goals is crucial for long-term results. Reliable preoperative planning strategies, including nomograms, measurement tools, and level selection, are key to maximizing the likelihood of achieving a good outcome following ASD corrective surgery. This review covers recent literature on such strategies, including review of the different targets for realignment and their association with outcomes (both patients-reported outcomes and complications), selection of upper and lower instrumented vertebrae, and the latest innovation in preoperative planning for deformity surgery.
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Affiliation(s)
- Jay Dalton
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA
| | - Ayman Mohamed
- Department of Orthopaedic Surgery, Lenox Hill Hospital, 130 East 77th Street, 11th Floor, New York, NY 10075, USA
| | - Noel Akioyamen
- Department of Orthopaedic Surgery, Monteriore Medical Center, 1250 Waters Place, Tower 1, 11th Floor, Bronx, NY 10461, USA
| | - Frank J Schwab
- Department of Orthopaedic Surgery, Lenox Hill Hospital, 130 East 77th Street, 11th Floor, New York, NY 10075, USA
| | - Virginie Lafage
- Department of Orthopaedic Surgery, Lenox Hill Hospital, 130 East 77th Street, 11th Floor, New York, NY 10075, USA.
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Yang H, Liu J, Hai Y, Han B. What Are the Benefits of Lateral Lumbar Interbody Fusion on the Treatment of Adult Spinal Deformity: A Systematic Review and Meta-Analysis Deformity. Global Spine J 2023; 13:172-187. [PMID: 35442824 PMCID: PMC9837508 DOI: 10.1177/21925682221089876] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
STUDY DESIGN A systematic review and meta-analysis. OBJECTIVE The purpose of this systematic review and meta-analysis was to compare the efficacy of lateral lumbar interbody fusion (LLIF) combined with posterior spinal fusion (PSF) with that of conventional PSF in the treatment of adult spinal deformity (ASD). METHODS A comprehensive literature search was performed for relevant studies in PubMed, EMBASE, Web of Science, and the Cochrane Library. Spinopelvic parameters, surgical data, complications, and clinical outcomes at the last follow-up were compared between patients with ASD who underwent LLIF combined with PSF (LLIF+PSF group) and those who underwent conventional PSF (only-PSF group). RESULTS Ten studies, comprising 621 patients with ASD (313 in the LLIF+PSF group and 308 in the only-PSF group), were included. The level of evidence was III for 7 studies and IV for 3 studies. There was no significant difference in the improvement in the visual analog scale score, systemic complication rate, and revision rate between groups. In the LLIF+PSF group, we noted a superior restoration of lumbar lordosis (weighted mean difference [WMD], 9.77; 95% confidence interval [CI] 7.10 to 12.44, P < .001), pelvic tilt (WMD, -2.50; 95% CI -4.25 to -.75, P = .005), sagittal vertical axis (WMD, -21.92; 95% CI -30.73 to -13.11, P < .001), and C7 plumb line-center sacral vertical line (WMD, -4.03; 95% CI -7.52 to -.54, P = .024); a lower estimated blood loss (WMD, -719.99; 95% CI -1105.02 to -334.96, P < .001) while a prolonged operating time (WMD, 104.89; 95% CI 49.36 to 160.43, P < .001); lower incidence of pseudarthrosis (risk ratio [RR], .26; 95% CI .08 to .79, P = .017) while higher incidence of neurologic deficits (RR, 2.04; 95% CI 1.27 to 3.25, P = .003); and a better improvement in Oswestry Disability Index score (WMD, -7.04; 95% CI -10.155 to -3.93, P < .001) and Scoliosis Research Society-22 total score (WMD, .27; 95% CI .11 to .42, P = .001). The level of evidence in this systematic review and meta-analysis was II. CONCLUSION Compared with conventional PSF, LLIF combined with PSF was associated with superior restoration of sagittal and coronal alignment, lower incidence of pseudarthrosis, better improvement in quality of life, and less surgical invasiveness in the treatment of ASD, albeit at the cost of prolonged surgical times and substantially high incidence of lower extremity symptoms. Surgeons should weigh the advantages and disadvantages of this procedure, and inform patients about its side effects.
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Affiliation(s)
- Honghao Yang
- Department of Orthopedic Surgery, Beijing Chao-Yang
Hospital, Beijing, China
| | - Jingwei Liu
- Department of Orthopedic Surgery, Beijing Chao-Yang
Hospital, Beijing, China
| | - Yong Hai
- Department of Orthopedic Surgery, Beijing Chao-Yang
Hospital, Beijing, China,*Yong Hai, Department of Orthopedic
Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Gongti South
Rd, No. 8, Beijing 100020, China.
| | - Bo Han
- Department of Orthopedic Surgery, Beijing Chao-Yang
Hospital, Beijing, China
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15
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Why are frailty indices not used systematically during preoperative spine consultations? REVISTA DE LA FACULTAD DE CIENCIAS MÉDICAS 2022; 79:347-352. [PMID: 36542577 PMCID: PMC9987299 DOI: 10.31053/1853.0605.v79.n4.37815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/04/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Frailty indices are highly predictive of major medical and mechanical complications, lengths of hospital stay, and mortality rates after spine procedures. However, several barriers limit the extent to which spine surgeons employ these indices. The main purposes of the current study were to assess the use of frailty indices by Latin-American spine surgeons and identify the main barriers perceived to restrict their clinical application. METHODS For this cross-sectional survey, a questionnaire evaluating the demographic characteristics of participating surgeons and their utilization of frailty indices were created in Google form and sent by e-mail to every registered member of AO Spine Latin America between October and November 2020. RESULTS Of the 1047 surgeons sent the survey, 293 responded (response rate=28%). Half of the surgeons (51.7%) said they were unfamiliar with the terms ¨frailty´ and ¨frailty index", while 70.3% claimed not to use any frailty scale during their pre-operative assessments. The most frequently utilized index was the modified Frailty Index (mFI) (18%). The most important perceived barrier was the excessive amount of time required to calculate each patient's frailty score. Ninety-two percent of the spine surgeons felt sure that these scores could influence their therapeutic decisions, while 91% desired an easier-to-use risk-prevention scale. CONCLUSION The main perceived barriers restricting the use of frailty indices were the time required to complete them, lack of index validation, and need for specific instruments to calculate the index score.
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Are Minimally Invasive Spine Surgeons or Classical Open Spine Surgeons More Consistent with Their Treatment of Adult Spinal Deformity? World Neurosurg 2022; 165:e51-e58. [PMID: 35643400 DOI: 10.1016/j.wneu.2022.05.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Spine surgeons have a heuristic sense of how to surgically restore alignment and address adult spinal deformity (ASD) symptoms, but consensus on the extent of treatment remains unclear. We sought to determine the variability of surgical approaches in treating ASD. METHODS Sixteen spine surgeons were surveyed on treatment approaches in 10 select ASD cases. We repeated the survey with the same surgeons 4 weeks later, with cases ordered differently. We examined the variability in length of construct, use of interbody spacers, osteotomies, and pelvic fixation frequency. RESULTS Treatment approaches for each case varied by surgeon, with some surgeons opting for long fusion constructs in cases for which others offered no surgery. There was no consensus among surgeons on the number of levels fused, interbody spacer use, or anterior/posterior osteotomies. Intersurgeon and intrasurgeon variability was 48% (kappa = 0.31) and 59% (kappa = 0.44) for surgeons performing minimally invasive surgery (MIS) versus 37% (kappa = 0.21) and 47% (kappa = 0.30) for those performing open surgery. In the second-round survey, 8 of 15 (53%) surgeons substantially changed the construct length, number of interbody spacers, and osteotomies in at least half the cases they previously reviewed. Surgeons performing MIS versus open surgery were less likely to extend constructs to the pelvis (42.5% vs. 67.5%; P = 0.02), but construct length was not correlated with whether a surgeon performed MIS or open surgery. CONCLUSIONS Spinal deformity surgeons lack consensus on the optimal surgical approach for treating ASD. Classifying surgeons as performing MIS or open surgery does not mitigate this variability.
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Shah NV, Kim DJ, Patel N, Beyer GA, Hollern DA, Wolfert AJ, Kim N, Suarez DE, Monessa D, Zhou PL, Eldib HM, Passias PG, Schwab FJ, Lafage V, Paulino CB, Diebo BG. The 5-factor modified frailty index (mFI-5) is predictive of 30-day postoperative complications and readmission in patients with adult spinal deformity (ASD). J Clin Neurosci 2022; 104:69-73. [PMID: 35981462 DOI: 10.1016/j.jocn.2022.07.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/19/2022] [Accepted: 07/24/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND There is limited research regarding the association between the mFI-5 and postoperative complications among adult spinal deformity (ASD) patients. METHODS Using the National Surgical Quality Improvement Project (NSQIP) database, patients with Current Procedural Terminology (CPT) codes for > 7-level fusion or < 7-level fusion with International Classification of Diseases, Ninth Revision (ICD-9) codes for ASD were identified between 2008 and 2016. Univariate analyses with post-hoc Bonferroni correction for demographics and preoperative factors were performed. Logistic regression assessed associations between mFI-5 scores and 30-day post-operative outcomes. RESULTS 2,120 patients met criteria. Patients with an mFI-5 score of 4 or 5 were excluded, given there were<20 patients with those scores. Patients with mFI-5 scores of 1 and 2 had increased 30-day rates of pneumonia (3.5 % and 4.3 % vs 1.6 %), unplanned postoperative ventilation for > 48 h (3.1 % and 4.3 % vs 0.9 %), and UTIs (4.4 % and 7.4 % vs 2.0 %) than patients with a score of 0 (all, p < 0.05). Logistic regression revealed that compared to an mFI-5 of 0, a score of 1 was an independent predictor of 30-day reoperations (OR = 1.4; 95 % CI 1.1-18). A score of 2 was an independent predictor of overall (OR = 2.4; 95 % CI 1.4-4.1) and related (OR = 2.2; 95 % CI 1.2-4.1) 30-day readmissions. A score of 3 was not predictive of any adverse outcome. CONCLUSION The mFI-5 score predicted complications and postoperative events in the ASD population. The mFI-5 may effectively predict 30-day readmissions. Further research is needed to identify the benefits and predictive value of mFI-5 as a risk assessment tool.
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Affiliation(s)
- Neil V Shah
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, NY, USA.
| | - David J Kim
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, NY, USA
| | - Neil Patel
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, NY, USA
| | - George A Beyer
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, NY, USA
| | - Douglas A Hollern
- Department of Orthopedic Surgery, USC Verdugo Hills Hospital, Los Angeles, CA, USA
| | - Adam J Wolfert
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, NY, USA
| | - Nathan Kim
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, NY, USA
| | - Daniel E Suarez
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, NY, USA
| | - Dan Monessa
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, NY, USA
| | - Peter L Zhou
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, NY, USA
| | - Hassan M Eldib
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, NY, USA
| | - Peter G Passias
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Frank J Schwab
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Virginie Lafage
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Carl B Paulino
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, NY, USA; Department of Orthopaedic Surgery, New York Presbyterian-Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Bassel G Diebo
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, NY, USA; Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
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18
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Jung JM, Chung CK, Kim CH, Yang SH, Ko YS. The Modified 11-Item Frailty Index and Postoperative Outcomes in Patients Undergoing Lateral Lumbar Interbody Fusion. Spine (Phila Pa 1976) 2022; 47:396-404. [PMID: 34669672 DOI: 10.1097/brs.0000000000004260] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE The aim of this study was to analyze postoperative complications and recovery patterns in different modified 11-item frailty index (mFI-11) groups after lateral lumbar interbody fusion (LLIF) surgery. SUMMARY OF BACKGROUND DATA The relationship between the mFI-11 score and LLIF surgery has not been previously reported. METHODS A single-center, consecutive series of patients who underwent LLIF with at least two years of follow-up were retrospectively reviewed. Complications after LLIF surgery were recorded. Clinical outcomes, including the visual analog scale (VAS) for back/leg pain and the Oswestry Disability Index (ODI), were evaluated preoperatively and at 1 and 2 years postoperatively. The proportions of patients who achieved substantial clinical benefit (SCB) for the VAS-B, VAS-L, and ODI were also analyzed. RESULTS One hundred fifty-two patients included in the present study were grouped according to their mFI-11 score: 0 (n = 39), 0.09 (n = 69), 0.18 (n = 31), and ≥0.27 (n = 13). An mFI-11 score ≥0.27 was a significant predictor of urinary complications (adjusted odds ratio: 3.829, P = 0.013). At 2 years postoperatively, patients in all frailty categories experienced improvements in the VAS for back pain, VAS for leg pain, and ODI, without significant differences between the four groups (p = 0.182, 0.121, and 0.804, respectively). There were also no significant differences in the proportions of patients achieving SCB for back/leg pain and the ODI between the four groups (P = 0.843, 0.957, and 0.915, respectively). CONCLUSION An mFI-11 score was found to be independently associated with urologic complications in patients who underwent LLIF. Patients in all frailty categories experienced significant improvements in back pain, leg pain, and the ODI at 1 year and 2 years postoperatively. LLIF surgery may be useful for patients with high frailty index.Level of Evidence: 4.
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Affiliation(s)
- Jong-Myung Jung
- Department of Neurosurgery, Spine Center, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
| | - Chi Heon Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seung Heon Yang
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young San Ko
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
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19
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Zileli M, Akıntürk N, Yaman O. Complications of adult spinal deformity surgery: A literature review. J Craniovertebr Junction Spine 2022; 13:17-26. [PMID: 35386240 PMCID: PMC8978850 DOI: 10.4103/jcvjs.jcvjs_159_21] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/03/2022] [Indexed: 11/15/2022] Open
Abstract
Purpose: Adult spinal deformity incidence increases accordingly as the population ages. Even though surgery is the best option for the treatment, the complications due to surgery are pretty challenging. This study aims to review the complication rates of adult spinal deformity surgery. Methods: A literature review of the last decade was performed searching for the query “Adult spine deformity and complication.” This search yielded 2781 results, where 79 articles were chosen to investigate the complications of adult spinal deformity surgery. In addition, the demographic data, surgical interventions, and complications were extracted from the publications. Results: A total of 26,207 patients were analyzed, and 9138 complications were found (34.5%). Implant failure, including screw loosening, breakage, distal and proximal junctional kyphosis, were the most common complications. The neurologic complications were about 10.8%, and the infection rate was 3.6%. Cardiac and pulmonary complications were about 4.8%. Discussion: Age, body mass index, smoking, osteoporosis, and other comorbidities are the significant risk factors affecting adult spinal deformity surgery. Presurgical planning and preoperative risk factor assessment must be done to avoid complications. Furthermore, intra and postoperative complications affect the patients’ quality of life and length of stay, and hospital readmissions. Revision surgery also increases the risk of complications. Conclusion: Good patient evaluation before surgery and careful planning of the surgery are essential in avoiding complications of adult spinal deformity.
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20
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Campagner A, Cabitza F, Berjano P, Ciucci D. Three-way decision and conformal prediction: Isomorphisms, differences and theoretical properties of cautious learning approaches. Inf Sci (N Y) 2021. [DOI: 10.1016/j.ins.2021.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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21
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Lakomkin N, Stannard B, Fogelson JL, Mikula AL, Lenke LG, Zuckerman SL. Comparison of surgical invasiveness and morbidity of adult spinal deformity surgery to other major operations. Spine J 2021; 21:1784-1792. [PMID: 34332146 DOI: 10.1016/j.spinee.2021.07.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 06/12/2021] [Accepted: 07/20/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Adult spinal deformity (ASD) surgeries are complex, involving long operative times and surgical morbidity. It is currently unclear how the invasiveness of ASD surgery compares to other major operations. PURPOSE To: (1) develop a quantitative score of surgical morbidity and invasiveness, and (2) compare this score between ASD surgery and other major operations. STUDY DESIGN Retrospective review of prospectively collected data. PATIENT SAMPLE A prospective surgical registry was used to identify all patients undergoing ASD surgery involving ≥ 7 segments. Seventeen additional procedures were included: coronary artery bypass grafting (CABG), pancreatectomy, and esophagectomy, among others. OUTCOME MEASURES Perioperative factors (operative time, transfusions, ventilation) and complications were collected and combined with a previously validated Postoperative Morbidity Survey to create a Surgical Invasiveness and Morbidity Score (SIMS). METHODS Computed scores were compared across surgeries using Welch's t-test. Multiple linear regression modeling was used to compare the SIMS of major surgeries relative to ASD while controlling for patient demographics and comorbidities. RESULTS A total of 1,245,282 surgical patients were included, 4,656 of which underwent ASD surgery. After multiple regression modeling controlling for patient demographics and comorbidities, ASD surgery ranked fourth in SIMS. ASD surgery had a significantly greater SIMS than 13 other major procedures including 6th esophagectomy (adjusted mean difference=-0.05, 95%CI -0.01-0.09, p<.001), 8th pancreatectomy (-0.40, 0.37-0.44, p<.001), 11th craniotomy for tumor (-1.01, 0.98-1.04, p<.001), and 12th sacral chordoma resection (-1.31, 1.26-1.37, p<.001). CONCLUSIONS ASD surgery was associated with significantly greater SIMS than many other major operations, even when controlling for important perioperative factors. These data have implications for patient counseling, resource allocation, and informed consent.
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Affiliation(s)
- Nikita Lakomkin
- Department of Neurologic Surgery, Mayo Clinic, Rochester MN, USA
| | - Blaine Stannard
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | | | - Anthony L Mikula
- Department of Neurologic Surgery, Mayo Clinic, Rochester MN, USA
| | - Lawrence G Lenke
- Department of Orthopaedic Surgery, Och Spine Hospital, Columbia University Medical Center, New York, NY, USA
| | - Scott L Zuckerman
- Department of Orthopaedic Surgery, Och Spine Hospital, Columbia University Medical Center, New York, NY, USA; Department of Neurological Surgery, Vanderbilt University, Nashville, TN, USA.
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22
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Lak AM, Abunimer AM, Goedmakers CMW, Aglio LS, Smith TR, Makhni M, Mekary RA, Zaidi HA. Single- versus Dual-Attending Surgeon Approach for Spine Deformity: A Systematic Review and Meta-Analysis. Oper Neurosurg (Hagerstown) 2021; 20:233-241. [PMID: 33372960 DOI: 10.1093/ons/opaa393] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 09/13/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Surgical management of spine deformity is associated with significant morbidity. Recent literature has inconsistently demonstrated better outcomes after utilizing 2 attending surgeons for spine deformity. OBJECTIVE To conduct a systematic review and meta-analysis on studies reporting outcomes following single- vs dual-attending surgeons for spine deformity. METHODS MEDLINE, Embase, Web of science, and Cochrane databases were last searched on July 16, 2020. A total of 1013 records were identified excluding duplicates. After screening, 10 studies (4 cohort, 6 case series) were included in the meta-analysis. Random-effect models were used to pool the effect estimates by study design. When feasible, further subgroup analysis by deformity type was conducted. RESULTS A total of 953 patients were analyzed. Pooled results from propensity score-matched cohort studies revealed that the single-surgeon approach was unfavorably associated with a nonstatistically significant higher blood loss (mean difference = 421.0 mL; 95% CI: -28.2, 870.2), a statistically significant higher operative time (mean difference = 94.3 min; 95% CI: 54.9, 133), length of stay (mean difference = 0.84 d; 95% CI: 0.46, 1.22), and an increased risk of complications (Mantel-Haenszel risk ratio = 2.93; 95% CI: 1.12, 7.66). Data from pooled case series demonstrated similar results for all outcomes. Moreover, these results did not differ significantly between deformity types (adolescent idiopathic scoliosis and adult spinal deformity). CONCLUSION Dual-attending surgeon approach appeared to be associated with reduced operative time, shorter hospital stays, and reduced risk of complications. These findings may potentially improve outcomes in surgical treatment of spine deformity.
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Affiliation(s)
- Asad M Lak
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Abdullah M Abunimer
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Caroline M W Goedmakers
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Linda S Aglio
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Anesthesia, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Timothy R Smith
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Melvin Makhni
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rania A Mekary
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,MCPHS University, Boston, Massachusetts
| | - Hasan A Zaidi
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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23
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Varshneya K, Pangal DJ, Stienen MN, Ho AL, Fatemi P, Medress ZA, Herrick DB, Desai A, Ratliff JK, Veeravagu A. Postoperative Complication Burden, Revision Risk, and Health Care Use in Obese Patients Undergoing Primary Adult Thoracolumbar Deformity Surgery. Global Spine J 2021; 11:345-350. [PMID: 32875891 PMCID: PMC8013946 DOI: 10.1177/2192568220904341] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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 This is a retrospective cohort study using a nationally representative administrative database. OBJECTIVE To identify the impact of obesity on postoperative outcomes in patients undergoing thoracolumbar adult spinal deformity (ASD) surgery. BACKGROUND The obesity rate in the United States remains staggering, with approximately one-third of all Americans being overweight or obese. However, the impact of elevated body mass index on spine surgery outcomes remains unclear. METHODS We queried the MarketScan database to identify patients who were diagnosed with a spinal deformity and underwent ASD surgery from 2007 to 2016. Patients were then stratified by whether or not they were diagnosed as obese at index surgical admission. Propensity score matching (PSM) was then utilized to mitigate intergroup differences between obese and nonobese patients. Patients <18 years and those with any prior history of trauma or tumor were excluded from this study. Baseline demographics and comorbidities, postoperative complication rates, and short- and long-term reoperation rates were determined. RESULTS A total of 7423 patients met the inclusion criteria of this study, of whom 597 (8.0%) were obese. Initially, patients with obesity had a higher 90-day postoperative complication rate than nonobese patients (46.1% vs 40.8%, P < .05); however, this difference did not remain after PSM. Revision surgery rates after 2 years were similar across the 2 groups following primary surgery (obese, 21.4%, vs nonobese, 22.0%; P = .7588). Health care use occurred at a higher rate among obese patients through 2 years of long-term follow-up (obese, $152 930, vs nonobese, $140 550; P < .05). CONCLUSION Patients diagnosed with obesity who underwent ASD surgery did not demonstrate increased rates of complications, reoperations, or readmissions. However, overall health care use through 2 years of follow-up after index surgery was higher in the obesity cohort.
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Affiliation(s)
| | | | - Martin N. Stienen
- Stanford University School of Medicine, Stanford, CA, USA
- University of Zurich, Zurich, Switzerland
| | - Allen L. Ho
- Stanford University School of Medicine, Stanford, CA, USA
| | | | | | | | - Atman Desai
- Stanford University School of Medicine, Stanford, CA, USA
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24
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Gupta A, Cha T, Schwab J, Fogel H, Tobert DG, Razi AE, Paulino C, Hecht AC, Bono CM, Hershman S. Osteoporosis is under recognized and undertreated in adult spinal deformity patients. JOURNAL OF SPINE SURGERY 2021; 7:1-7. [PMID: 33834122 DOI: 10.21037/jss-20-668] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Adult spinal deformity (ASD) patients may have osteoporosis, predisposing them to an increased risk for surgical complications. Prior studies have demonstrated that treating osteoporosis improves surgical outcomes. In this study we determine the prevalence of osteoporosis in ASD patients undergoing long spinal fusions and the rate at which osteoporosis is treated. Methods ASD patients who frequented either of two major academic medical centers from 2010 through 2019 were studied. All study participants were at least 40 years of age and endured a spinal fusion of at least seven vertebral levels. Medical records were explored for a diagnosis of osteoporosis via ICD-10 code and, if present, whether pharmacological treatment was prescribed. T-tests and chi-squared analyses were used to determine statistical significance. Results Three hundred ninety-nine patients matched the study's inclusion criteria. Among this group, 131 patients (32.8%) had been diagnosed with osteoporosis prior to surgery. With a mean age of 66.4 years, osteoporotic patients were on average three years older than non-osteoporotic (P=0.002) and more likely to be female (74.8% vs. 61.9%; P=0.01). At the time of surgery, 34.4% of osteoporotic patients were receiving pharmacological treatment. Although not statistically significant, women were more likely to receive medical treatment than men (P=0.07). Conclusions The prevalence of osteoporosis in ASD patients undergoing a long spinal fusion is substantially higher than that of the general population. Surgeons should have a low threshold for bone density testing in ASD patients. With only about one-third of osteoporotic patients treated, there is a classic "missed opportunity" in this population.
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Affiliation(s)
- Anmol Gupta
- Department of Orthopaedics, The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Orthopaedics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Thomas Cha
- Department of Orthopaedics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Joseph Schwab
- Department of Orthopaedics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Harold Fogel
- Department of Orthopaedics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel G Tobert
- Department of Orthopaedics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Afshin E Razi
- Department of Orthopaedics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Maimonides Bone and Joint Center, Maimonides Medical Center, Brooklyn, NY, USA
| | - Carl Paulino
- Department of Orthopaedic Surgery, Fe Health Sciences University, New York-Presbyterian (NYP) Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Andrew C Hecht
- Department of Orthopaedics, The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christopher M Bono
- Department of Orthopaedics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Stuart Hershman
- Department of Orthopaedics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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25
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Sciubba D, Jain A, Kebaish KM, Neuman BJ, Daniels AH, Passias PG, Kim HJ, Protopsaltis TS, Scheer JK, Smith JS, Hamilton K, Bess S, Klineberg EO, Ames CP. Development of a Preoperative Adult Spinal Deformity Comorbidity Score That Correlates With Common Quality and Value Metrics: Length of Stay, Major Complications, and Patient-Reported Outcomes. Global Spine J 2021; 11:146-153. [PMID: 32875843 PMCID: PMC7882823 DOI: 10.1177/2192568219894951] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
STUDY DESIGN Retrospective review of a multicenter prospective registry. OBJECTIVES Our goal was to develop a method to risk-stratify adult spinal deformity (ASD) patients on the basis of their accumulated health deficits. We developed a novel comorbidity score (CS) specific to patients with ASD based on their preoperative health state and investigated whether it was associated with major complications, length of hospital stay (LOS), and self-reported outcomes after ASD surgery. METHODS We identified 273 operatively treated ASD patients with 2-year follow-up. We assessed associations between major complications and age, comorbidities, Charlson Comorbidity Index score, and Oswestry Disability Index score. Significant factors were used to construct the ASD-CS. Associations of ASD-CS with major complications, LOS, and patient-reported outcomes were analyzed. RESULTS Major complications increased significantly with ASD-CS (P < .01). Compared with patients with ASD-CS of 0, the odds of major complications were 2.8-fold higher (P = .068) in patients with ASD-CS of 1 through 3; 4.5-fold higher (P < .01) in patients with ASD-CS of 4 through 6; and 7.5-fold higher (P < .01) in patients with ASD-CS of 7 or 8. Patients with ASD-CS of 7 or 8 had the longest mean LOS (10.7 days) and worst mean Scoliosis Research Society-22r total score at baseline; however, they experienced the greatest mean improvement (0.98 points) over 2 years. CONCLUSIONS The ASD-CS is significantly associated with major complications, LOS, and patient-reported outcomes in operatively treated ASD patients.
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Affiliation(s)
| | - Amit Jain
- The Johns Hopkins University, Baltimore, MD, USA
| | - Khaled M. Kebaish
- The Johns Hopkins University, Baltimore, MD, USA,Khaled M Kebaish, Department of Orthopaedic Surgery, The Johns Hopkins University, 601 North Caroline Street, Baltimore, MD 21287, USA.
| | | | - Alan H. Daniels
- The Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Han J. Kim
- Hospital for Special Surgery, New York, NY, USA
| | | | | | - Justin S. Smith
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Kojo Hamilton
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Shay Bess
- New York University, New York, NY, USA
| | - Eric O. Klineberg
- University of California Davis School of Medicine, Sacramento, CA, USA
| | - Christopher P. Ames
- University of California San Francisco School of Medicine, San Francisco, CA, USA
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26
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Poelstra KA. CORR Insights®: Are Higher Global Alignment and Proportion Scores Associated With Increased Risks of Mechanical Complications After Adult Spinal Deformity Surgery? An External Validation. Clin Orthop Relat Res 2021; 479:321-323. [PMID: 33332886 PMCID: PMC7899402 DOI: 10.1097/corr.0000000000001612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 11/25/2020] [Indexed: 01/31/2023]
Affiliation(s)
- Kornelis A Poelstra
- K. A. Poelstra, The Robotic Spine Institute of Las Vegas at Allegiant Pain & Spine, Las Vegas, NV, USA
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27
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Kwan KYH, Lenke LG, Shaffrey CI, Carreon LY, Dahl BT, Fehlings MG, Ames CP, Boachie-Adjei O, Dekutoski MB, Kebaish KM, Lewis SJ, Matsuyama Y, Mehdian H, Qiu Y, Schwab FJ, Cheung KMC. Are Higher Global Alignment and Proportion Scores Associated With Increased Risks of Mechanical Complications After Adult Spinal Deformity Surgery? An External Validation. Clin Orthop Relat Res 2021; 479:312-320. [PMID: 33079774 PMCID: PMC7899533 DOI: 10.1097/corr.0000000000001521] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 09/10/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND The Global Alignment and Proportion (GAP) score, based on pelvic incidence-based proportional parameters, was recently developed to predict mechanical complications after surgery for spinal deformities in adults. However, this score has not been validated in an independent external dataset. QUESTIONS/PURPOSES After adult spinal deformity surgery, is a higher GAP score associated with (1) an increased risk of mechanical complications, defined as rod fractures, implant-related complications, proximal or distal junctional kyphosis or failure; (2) a higher likelihood of undergoing revision surgery to treat a mechanical complication; and (3) is a lower (more proportioned) GAP score category associated with better validated outcomes scores using the Oswestry Disability Index (ODI), Scoliosis Research Society-22 (SRS-22) and the Short Form-36 questionnaires? METHODS A total of 272 patients who had undergone corrective surgeries for complex spinal deformities were enrolled in the Scoli-RISK-1 prospective trial. Patients were included in this secondary analysis if they fulfilled the original inclusion criteria by Yilgor et al. From the original 272 patients, 14% (39) did not satisfy the radiographic inclusion criteria, the GAP score could not be calculated in 14% (37), and 24% (64) did not have radiographic assessment at postoperative 2 years, leaving 59% (159) for analysis in this review of data from the original trial. A total of 159 patients were included in this study,with a mean age of 58 ± 14 years at the time of surgery. Most patients were female (72%, 115 of 159), the mean number of levels involved in surgery was 12 ± 4, and three-column osteotomy was performed in 76% (120 of 159) of patients. The GAP score was calculated using parameters from early postoperative radiographs (between 3 and 12 weeks) including pelvic incidence, sacral slope, lumbar lordosis, lower arc lordosis and global tilt, which were independently obtained from a computer software based on centralized patient radiographs. The GAP score was categorized as proportional (scores of 0 to 2), moderately disproportional (scores of 3 to 6), or severely disproportional (scores higher than 7 to 13). Receiver operating characteristic area under curve (AUC) was used to assess associations between GAP score and risk of mechanical complications and risk of revision surgery. An AUC of 0.5 to 0.7 was classified as "no or low associative power", 0.7 to 0.9 as "moderate" and greater than 0.9 as "high". We analyzed differences in validated outcome scores between the GAP categories using Wilcoxon rank sum test. RESULTS At a minimum of 2 years' follow-up, a higher GAP score was not associated with increased risks of mechanical complications (AUC = 0.60 [95% CI 0.50 to 0.70]). A higher GAP score was not associated with a higher likelihood of undergoing a revision surgery to treat a mechanical complication (AUC = 0.66 [95% 0.53 to 0.78]). However, a moderately disproportioned GAP score category was associated with better SF-36 physical component summary score (36 ± 10 versus 40 ± 11; p = 0.047), better SF-36 mental component summary score (46 ± 13 versus 51 ± 12; p = 0.01), better SRS-22 total score (3.4 ± 0.8 versus 3.7 ± 0.7, p = 0.02) and better ODI score (35 ± 21 versus 25 ± 20; p = 0.003) than severely disproportioned GAP score category. CONCLUSION Based on the findings of this external validation study, we found that alignment targets based on the GAP score alone were not associated with increased risks of mechanical complications and mechanical revisions in patients with complex adult spinal disorders. Parameters not included in the original GAP score needed to be considered to reduce the likelihood of mechanical complications. LEVEL OF EVIDENCE Level III, diagnostic study.
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Affiliation(s)
- Kenny Yat Hong Kwan
- K. Y. H. Kwan, The University of Hong Kong, Pokfulam, Hong Kong
- L. G. Lenke, Columbia University Medical Center, New York, NY, USA
- C. I. Shaffrey, University of Virginia Medical Center, Charlottesville, VA, USA
- L. Y. Carreon, Norton Leatherman Spine Center, Louisville, KY, USA
- B. T. Dahl, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- B. T. Dahl, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
- M. G. Fehlings, S. J. Lewis, University of Toronto and Toronto Western Hospital, Toronto, ON, Canada
- C. P. Ames, University of California San Francisco, San Francisco, CA, USA
- O. Boachie-Adjei, The Foundation of Orthopedics and Complex Spine Hospital, Pantang West, Republic of Ghana
- M. B. Dekutoski, Marshfield Clinic Eau Claire Center, Eau Claire, WI, USA
- K. M. Kebaish, Johns Hopkins University, Baltimore, MD, USA
- Y. Matsuyama, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
- H. Mehdian, University Hospital, Queen's Medical Centre, Nottingham, UK
- Y. Qiu, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
- F. J. Schwab, Hospital for Special Surgery, New York, NY, USA
- K. M. C. Cheung, The University of Hong Kong, Pokfulam, Hong Kong
| | - Lawrence G Lenke
- K. Y. H. Kwan, The University of Hong Kong, Pokfulam, Hong Kong
- L. G. Lenke, Columbia University Medical Center, New York, NY, USA
- C. I. Shaffrey, University of Virginia Medical Center, Charlottesville, VA, USA
- L. Y. Carreon, Norton Leatherman Spine Center, Louisville, KY, USA
- B. T. Dahl, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- B. T. Dahl, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
- M. G. Fehlings, S. J. Lewis, University of Toronto and Toronto Western Hospital, Toronto, ON, Canada
- C. P. Ames, University of California San Francisco, San Francisco, CA, USA
- O. Boachie-Adjei, The Foundation of Orthopedics and Complex Spine Hospital, Pantang West, Republic of Ghana
- M. B. Dekutoski, Marshfield Clinic Eau Claire Center, Eau Claire, WI, USA
- K. M. Kebaish, Johns Hopkins University, Baltimore, MD, USA
- Y. Matsuyama, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
- H. Mehdian, University Hospital, Queen's Medical Centre, Nottingham, UK
- Y. Qiu, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
- F. J. Schwab, Hospital for Special Surgery, New York, NY, USA
- K. M. C. Cheung, The University of Hong Kong, Pokfulam, Hong Kong
| | - Christopher I Shaffrey
- K. Y. H. Kwan, The University of Hong Kong, Pokfulam, Hong Kong
- L. G. Lenke, Columbia University Medical Center, New York, NY, USA
- C. I. Shaffrey, University of Virginia Medical Center, Charlottesville, VA, USA
- L. Y. Carreon, Norton Leatherman Spine Center, Louisville, KY, USA
- B. T. Dahl, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- B. T. Dahl, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
- M. G. Fehlings, S. J. Lewis, University of Toronto and Toronto Western Hospital, Toronto, ON, Canada
- C. P. Ames, University of California San Francisco, San Francisco, CA, USA
- O. Boachie-Adjei, The Foundation of Orthopedics and Complex Spine Hospital, Pantang West, Republic of Ghana
- M. B. Dekutoski, Marshfield Clinic Eau Claire Center, Eau Claire, WI, USA
- K. M. Kebaish, Johns Hopkins University, Baltimore, MD, USA
- Y. Matsuyama, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
- H. Mehdian, University Hospital, Queen's Medical Centre, Nottingham, UK
- Y. Qiu, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
- F. J. Schwab, Hospital for Special Surgery, New York, NY, USA
- K. M. C. Cheung, The University of Hong Kong, Pokfulam, Hong Kong
| | - Leah Y Carreon
- K. Y. H. Kwan, The University of Hong Kong, Pokfulam, Hong Kong
- L. G. Lenke, Columbia University Medical Center, New York, NY, USA
- C. I. Shaffrey, University of Virginia Medical Center, Charlottesville, VA, USA
- L. Y. Carreon, Norton Leatherman Spine Center, Louisville, KY, USA
- B. T. Dahl, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- B. T. Dahl, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
- M. G. Fehlings, S. J. Lewis, University of Toronto and Toronto Western Hospital, Toronto, ON, Canada
- C. P. Ames, University of California San Francisco, San Francisco, CA, USA
- O. Boachie-Adjei, The Foundation of Orthopedics and Complex Spine Hospital, Pantang West, Republic of Ghana
- M. B. Dekutoski, Marshfield Clinic Eau Claire Center, Eau Claire, WI, USA
- K. M. Kebaish, Johns Hopkins University, Baltimore, MD, USA
- Y. Matsuyama, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
- H. Mehdian, University Hospital, Queen's Medical Centre, Nottingham, UK
- Y. Qiu, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
- F. J. Schwab, Hospital for Special Surgery, New York, NY, USA
- K. M. C. Cheung, The University of Hong Kong, Pokfulam, Hong Kong
| | - Benny T Dahl
- K. Y. H. Kwan, The University of Hong Kong, Pokfulam, Hong Kong
- L. G. Lenke, Columbia University Medical Center, New York, NY, USA
- C. I. Shaffrey, University of Virginia Medical Center, Charlottesville, VA, USA
- L. Y. Carreon, Norton Leatherman Spine Center, Louisville, KY, USA
- B. T. Dahl, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- B. T. Dahl, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
- M. G. Fehlings, S. J. Lewis, University of Toronto and Toronto Western Hospital, Toronto, ON, Canada
- C. P. Ames, University of California San Francisco, San Francisco, CA, USA
- O. Boachie-Adjei, The Foundation of Orthopedics and Complex Spine Hospital, Pantang West, Republic of Ghana
- M. B. Dekutoski, Marshfield Clinic Eau Claire Center, Eau Claire, WI, USA
- K. M. Kebaish, Johns Hopkins University, Baltimore, MD, USA
- Y. Matsuyama, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
- H. Mehdian, University Hospital, Queen's Medical Centre, Nottingham, UK
- Y. Qiu, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
- F. J. Schwab, Hospital for Special Surgery, New York, NY, USA
- K. M. C. Cheung, The University of Hong Kong, Pokfulam, Hong Kong
| | - Michael G Fehlings
- K. Y. H. Kwan, The University of Hong Kong, Pokfulam, Hong Kong
- L. G. Lenke, Columbia University Medical Center, New York, NY, USA
- C. I. Shaffrey, University of Virginia Medical Center, Charlottesville, VA, USA
- L. Y. Carreon, Norton Leatherman Spine Center, Louisville, KY, USA
- B. T. Dahl, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- B. T. Dahl, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
- M. G. Fehlings, S. J. Lewis, University of Toronto and Toronto Western Hospital, Toronto, ON, Canada
- C. P. Ames, University of California San Francisco, San Francisco, CA, USA
- O. Boachie-Adjei, The Foundation of Orthopedics and Complex Spine Hospital, Pantang West, Republic of Ghana
- M. B. Dekutoski, Marshfield Clinic Eau Claire Center, Eau Claire, WI, USA
- K. M. Kebaish, Johns Hopkins University, Baltimore, MD, USA
- Y. Matsuyama, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
- H. Mehdian, University Hospital, Queen's Medical Centre, Nottingham, UK
- Y. Qiu, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
- F. J. Schwab, Hospital for Special Surgery, New York, NY, USA
- K. M. C. Cheung, The University of Hong Kong, Pokfulam, Hong Kong
| | - Christopher P Ames
- K. Y. H. Kwan, The University of Hong Kong, Pokfulam, Hong Kong
- L. G. Lenke, Columbia University Medical Center, New York, NY, USA
- C. I. Shaffrey, University of Virginia Medical Center, Charlottesville, VA, USA
- L. Y. Carreon, Norton Leatherman Spine Center, Louisville, KY, USA
- B. T. Dahl, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- B. T. Dahl, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
- M. G. Fehlings, S. J. Lewis, University of Toronto and Toronto Western Hospital, Toronto, ON, Canada
- C. P. Ames, University of California San Francisco, San Francisco, CA, USA
- O. Boachie-Adjei, The Foundation of Orthopedics and Complex Spine Hospital, Pantang West, Republic of Ghana
- M. B. Dekutoski, Marshfield Clinic Eau Claire Center, Eau Claire, WI, USA
- K. M. Kebaish, Johns Hopkins University, Baltimore, MD, USA
- Y. Matsuyama, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
- H. Mehdian, University Hospital, Queen's Medical Centre, Nottingham, UK
- Y. Qiu, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
- F. J. Schwab, Hospital for Special Surgery, New York, NY, USA
- K. M. C. Cheung, The University of Hong Kong, Pokfulam, Hong Kong
| | - Oheneba Boachie-Adjei
- K. Y. H. Kwan, The University of Hong Kong, Pokfulam, Hong Kong
- L. G. Lenke, Columbia University Medical Center, New York, NY, USA
- C. I. Shaffrey, University of Virginia Medical Center, Charlottesville, VA, USA
- L. Y. Carreon, Norton Leatherman Spine Center, Louisville, KY, USA
- B. T. Dahl, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- B. T. Dahl, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
- M. G. Fehlings, S. J. Lewis, University of Toronto and Toronto Western Hospital, Toronto, ON, Canada
- C. P. Ames, University of California San Francisco, San Francisco, CA, USA
- O. Boachie-Adjei, The Foundation of Orthopedics and Complex Spine Hospital, Pantang West, Republic of Ghana
- M. B. Dekutoski, Marshfield Clinic Eau Claire Center, Eau Claire, WI, USA
- K. M. Kebaish, Johns Hopkins University, Baltimore, MD, USA
- Y. Matsuyama, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
- H. Mehdian, University Hospital, Queen's Medical Centre, Nottingham, UK
- Y. Qiu, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
- F. J. Schwab, Hospital for Special Surgery, New York, NY, USA
- K. M. C. Cheung, The University of Hong Kong, Pokfulam, Hong Kong
| | - Mark B Dekutoski
- K. Y. H. Kwan, The University of Hong Kong, Pokfulam, Hong Kong
- L. G. Lenke, Columbia University Medical Center, New York, NY, USA
- C. I. Shaffrey, University of Virginia Medical Center, Charlottesville, VA, USA
- L. Y. Carreon, Norton Leatherman Spine Center, Louisville, KY, USA
- B. T. Dahl, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- B. T. Dahl, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
- M. G. Fehlings, S. J. Lewis, University of Toronto and Toronto Western Hospital, Toronto, ON, Canada
- C. P. Ames, University of California San Francisco, San Francisco, CA, USA
- O. Boachie-Adjei, The Foundation of Orthopedics and Complex Spine Hospital, Pantang West, Republic of Ghana
- M. B. Dekutoski, Marshfield Clinic Eau Claire Center, Eau Claire, WI, USA
- K. M. Kebaish, Johns Hopkins University, Baltimore, MD, USA
- Y. Matsuyama, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
- H. Mehdian, University Hospital, Queen's Medical Centre, Nottingham, UK
- Y. Qiu, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
- F. J. Schwab, Hospital for Special Surgery, New York, NY, USA
- K. M. C. Cheung, The University of Hong Kong, Pokfulam, Hong Kong
| | - Khaled M Kebaish
- K. Y. H. Kwan, The University of Hong Kong, Pokfulam, Hong Kong
- L. G. Lenke, Columbia University Medical Center, New York, NY, USA
- C. I. Shaffrey, University of Virginia Medical Center, Charlottesville, VA, USA
- L. Y. Carreon, Norton Leatherman Spine Center, Louisville, KY, USA
- B. T. Dahl, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- B. T. Dahl, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
- M. G. Fehlings, S. J. Lewis, University of Toronto and Toronto Western Hospital, Toronto, ON, Canada
- C. P. Ames, University of California San Francisco, San Francisco, CA, USA
- O. Boachie-Adjei, The Foundation of Orthopedics and Complex Spine Hospital, Pantang West, Republic of Ghana
- M. B. Dekutoski, Marshfield Clinic Eau Claire Center, Eau Claire, WI, USA
- K. M. Kebaish, Johns Hopkins University, Baltimore, MD, USA
- Y. Matsuyama, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
- H. Mehdian, University Hospital, Queen's Medical Centre, Nottingham, UK
- Y. Qiu, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
- F. J. Schwab, Hospital for Special Surgery, New York, NY, USA
- K. M. C. Cheung, The University of Hong Kong, Pokfulam, Hong Kong
| | - Stephen J Lewis
- K. Y. H. Kwan, The University of Hong Kong, Pokfulam, Hong Kong
- L. G. Lenke, Columbia University Medical Center, New York, NY, USA
- C. I. Shaffrey, University of Virginia Medical Center, Charlottesville, VA, USA
- L. Y. Carreon, Norton Leatherman Spine Center, Louisville, KY, USA
- B. T. Dahl, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- B. T. Dahl, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
- M. G. Fehlings, S. J. Lewis, University of Toronto and Toronto Western Hospital, Toronto, ON, Canada
- C. P. Ames, University of California San Francisco, San Francisco, CA, USA
- O. Boachie-Adjei, The Foundation of Orthopedics and Complex Spine Hospital, Pantang West, Republic of Ghana
- M. B. Dekutoski, Marshfield Clinic Eau Claire Center, Eau Claire, WI, USA
- K. M. Kebaish, Johns Hopkins University, Baltimore, MD, USA
- Y. Matsuyama, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
- H. Mehdian, University Hospital, Queen's Medical Centre, Nottingham, UK
- Y. Qiu, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
- F. J. Schwab, Hospital for Special Surgery, New York, NY, USA
- K. M. C. Cheung, The University of Hong Kong, Pokfulam, Hong Kong
| | - Yukihiro Matsuyama
- K. Y. H. Kwan, The University of Hong Kong, Pokfulam, Hong Kong
- L. G. Lenke, Columbia University Medical Center, New York, NY, USA
- C. I. Shaffrey, University of Virginia Medical Center, Charlottesville, VA, USA
- L. Y. Carreon, Norton Leatherman Spine Center, Louisville, KY, USA
- B. T. Dahl, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- B. T. Dahl, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
- M. G. Fehlings, S. J. Lewis, University of Toronto and Toronto Western Hospital, Toronto, ON, Canada
- C. P. Ames, University of California San Francisco, San Francisco, CA, USA
- O. Boachie-Adjei, The Foundation of Orthopedics and Complex Spine Hospital, Pantang West, Republic of Ghana
- M. B. Dekutoski, Marshfield Clinic Eau Claire Center, Eau Claire, WI, USA
- K. M. Kebaish, Johns Hopkins University, Baltimore, MD, USA
- Y. Matsuyama, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
- H. Mehdian, University Hospital, Queen's Medical Centre, Nottingham, UK
- Y. Qiu, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
- F. J. Schwab, Hospital for Special Surgery, New York, NY, USA
- K. M. C. Cheung, The University of Hong Kong, Pokfulam, Hong Kong
| | - Hossein Mehdian
- K. Y. H. Kwan, The University of Hong Kong, Pokfulam, Hong Kong
- L. G. Lenke, Columbia University Medical Center, New York, NY, USA
- C. I. Shaffrey, University of Virginia Medical Center, Charlottesville, VA, USA
- L. Y. Carreon, Norton Leatherman Spine Center, Louisville, KY, USA
- B. T. Dahl, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- B. T. Dahl, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
- M. G. Fehlings, S. J. Lewis, University of Toronto and Toronto Western Hospital, Toronto, ON, Canada
- C. P. Ames, University of California San Francisco, San Francisco, CA, USA
- O. Boachie-Adjei, The Foundation of Orthopedics and Complex Spine Hospital, Pantang West, Republic of Ghana
- M. B. Dekutoski, Marshfield Clinic Eau Claire Center, Eau Claire, WI, USA
- K. M. Kebaish, Johns Hopkins University, Baltimore, MD, USA
- Y. Matsuyama, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
- H. Mehdian, University Hospital, Queen's Medical Centre, Nottingham, UK
- Y. Qiu, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
- F. J. Schwab, Hospital for Special Surgery, New York, NY, USA
- K. M. C. Cheung, The University of Hong Kong, Pokfulam, Hong Kong
| | - Yong Qiu
- K. Y. H. Kwan, The University of Hong Kong, Pokfulam, Hong Kong
- L. G. Lenke, Columbia University Medical Center, New York, NY, USA
- C. I. Shaffrey, University of Virginia Medical Center, Charlottesville, VA, USA
- L. Y. Carreon, Norton Leatherman Spine Center, Louisville, KY, USA
- B. T. Dahl, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- B. T. Dahl, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
- M. G. Fehlings, S. J. Lewis, University of Toronto and Toronto Western Hospital, Toronto, ON, Canada
- C. P. Ames, University of California San Francisco, San Francisco, CA, USA
- O. Boachie-Adjei, The Foundation of Orthopedics and Complex Spine Hospital, Pantang West, Republic of Ghana
- M. B. Dekutoski, Marshfield Clinic Eau Claire Center, Eau Claire, WI, USA
- K. M. Kebaish, Johns Hopkins University, Baltimore, MD, USA
- Y. Matsuyama, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
- H. Mehdian, University Hospital, Queen's Medical Centre, Nottingham, UK
- Y. Qiu, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
- F. J. Schwab, Hospital for Special Surgery, New York, NY, USA
- K. M. C. Cheung, The University of Hong Kong, Pokfulam, Hong Kong
| | - Frank J Schwab
- K. Y. H. Kwan, The University of Hong Kong, Pokfulam, Hong Kong
- L. G. Lenke, Columbia University Medical Center, New York, NY, USA
- C. I. Shaffrey, University of Virginia Medical Center, Charlottesville, VA, USA
- L. Y. Carreon, Norton Leatherman Spine Center, Louisville, KY, USA
- B. T. Dahl, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- B. T. Dahl, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
- M. G. Fehlings, S. J. Lewis, University of Toronto and Toronto Western Hospital, Toronto, ON, Canada
- C. P. Ames, University of California San Francisco, San Francisco, CA, USA
- O. Boachie-Adjei, The Foundation of Orthopedics and Complex Spine Hospital, Pantang West, Republic of Ghana
- M. B. Dekutoski, Marshfield Clinic Eau Claire Center, Eau Claire, WI, USA
- K. M. Kebaish, Johns Hopkins University, Baltimore, MD, USA
- Y. Matsuyama, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
- H. Mehdian, University Hospital, Queen's Medical Centre, Nottingham, UK
- Y. Qiu, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
- F. J. Schwab, Hospital for Special Surgery, New York, NY, USA
- K. M. C. Cheung, The University of Hong Kong, Pokfulam, Hong Kong
| | - Kenneth Man Chee Cheung
- K. Y. H. Kwan, The University of Hong Kong, Pokfulam, Hong Kong
- L. G. Lenke, Columbia University Medical Center, New York, NY, USA
- C. I. Shaffrey, University of Virginia Medical Center, Charlottesville, VA, USA
- L. Y. Carreon, Norton Leatherman Spine Center, Louisville, KY, USA
- B. T. Dahl, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- B. T. Dahl, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
- M. G. Fehlings, S. J. Lewis, University of Toronto and Toronto Western Hospital, Toronto, ON, Canada
- C. P. Ames, University of California San Francisco, San Francisco, CA, USA
- O. Boachie-Adjei, The Foundation of Orthopedics and Complex Spine Hospital, Pantang West, Republic of Ghana
- M. B. Dekutoski, Marshfield Clinic Eau Claire Center, Eau Claire, WI, USA
- K. M. Kebaish, Johns Hopkins University, Baltimore, MD, USA
- Y. Matsuyama, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
- H. Mehdian, University Hospital, Queen's Medical Centre, Nottingham, UK
- Y. Qiu, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
- F. J. Schwab, Hospital for Special Surgery, New York, NY, USA
- K. M. C. Cheung, The University of Hong Kong, Pokfulam, Hong Kong
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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: 19] [Impact Index Per Article: 3.8] [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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Sun W, Lu S, Kong C, Li Z, Wang P, Zhang S. Frailty and Post-Operative Outcomes in the Older Patients Undergoing Elective Posterior Thoracolumbar Fusion Surgery. Clin Interv Aging 2020; 15:1141-1150. [PMID: 32764901 PMCID: PMC7369366 DOI: 10.2147/cia.s245419] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 07/03/2020] [Indexed: 12/21/2022] Open
Abstract
Background and Aim Frailty is an independent predictor of mortality and adverse events (AEs) in patients undergoing surgery. This study aimed to quantify the ability of Modified Frailty Index (mFI) to predict AEs in older patients undergoing elective posterior thoracolumbar fusion surgery. Methods We retrospectively reviewed the results of 426 patients with the following diagnoses and follow-up evaluations of at least 12 months duration: lumbar disc herniation, 125; degenerative spondylolisthesis, 81; lumbar spinal canal stenosis, 187; and adult spinal deformities, 33. The cases were divided into two groups. The long spinal fusion (LSF) group was defined as ≥3 spinal levels with segmental pedicle-screw fixation. Short spinal fusion (SSF) were defined with at most two levels. The mFI used in the present study is an 11-variable assessment. The association of frailty with AEs was determined after adjusting for known and suspected confounders. Results Frailty was presented in 66 patients (15.5%) within the total population (LSF, 21.9% and SSF, 11.8%). Rates of AEs assessed in the study increased stepwise with an increase in the mFI for the two groups. The severity of frailty was an independent predictor of any, major, and minor complications in the LSF group and any, minor complication in the SSF group (P<0.05). A comparison of post-operative clinical outcomes showed that the ODI and SF-36 scores deteriorated as the mFI increased. Conclusion Frailty was shown to be an independent predictor of AEs in older patients undergoing elective posterior thoracolumbar fusion surgery, especially for patients undergoing LSF.
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Affiliation(s)
- Wenzhi Sun
- Department of Orthopaedics, Capital Medical University Xuanwu Hospital, Beijing 100053, People's Republic of China
| | - Shibao Lu
- Department of Orthopaedics, Capital Medical University Xuanwu Hospital, Beijing 100053, People's Republic of China
| | - Chao Kong
- Department of Orthopaedics, Capital Medical University Xuanwu Hospital, Beijing 100053, People's Republic of China
| | - Zhongen Li
- Department of Orthopaedics, Capital Medical University Xuanwu Hospital, Beijing 100053, People's Republic of China
| | - Peng Wang
- Department of Orthopaedics, Capital Medical University Xuanwu Hospital, Beijing 100053, People's Republic of China
| | - Sitao Zhang
- Department of Orthopaedics, Capital Medical University Xuanwu Hospital, Beijing 100053, People's Republic of China
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Daniels AH, Reid DBC, Durand WM, Line B, Passias P, Kim HJ, Protopsaltis T, LaFage V, Smith JS, Shaffrey C, Gupta M, Klineberg E, Schwab F, Burton D, Bess S, Ames C, Hart RA. Assessment of Patient Outcomes and Proximal Junctional Failure Rate of Patients with Adult Spinal Deformity Undergoing Caudal Extension of Previous Spinal Fusion. World Neurosurg 2020; 139:e449-e454. [PMID: 32305603 DOI: 10.1016/j.wneu.2020.04.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/03/2020] [Accepted: 04/04/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE This case series examined patients undergoing caudal extension of prior fusion without alteration of the prior upper instrumented vertebra (UIV) to assess patient outcomes and rates of proximal junctional kyphosis (PJK)/proximal junctional failure (PJF). METHODS Patients eligible for 2-year minimum follow-up undergoing caudal extension of prior fusion with unchanged UIVs were identified. These patients were evaluated for PJK/PJF, and patient reported outcomes were recorded. RESULTS In total, 40 patients were included. Mean follow-up duration was 2.2 ± 0.3 years. Patients in this cohort had poor preoperative sagittal alignment (pelvic incidence minus lumbar lordosis [PI-LL] 26.7°, T1 pelvic angle [TPA] 29.0°, sagittal vertical axis [SVA] 93.4 mm) and achieved substantial sagittal correction (ΔSVA -62.2 mm, ΔPI-LL -19.8°, ΔTPA -11.1°) after caudal extension surgery. At final follow-up, there was a 0% rate of PJF among patients undergoing caudal extension of previous fusion without creation of a new UIV, but 27.5% of patients experienced PJK. Patients experienced significant improvement in both the Oswestry Disability Index and Scoliosis Research Society-22r total score at 2 years postoperatively (P < 0.05). In total, 7.5% (n = 3) of patients underwent further revision, at an average of 1.1 ± 0.54 years after the surgery with unaltered UIV. All 3 of these patients underwent revision for rod fracture with no revisions for PJK/PJF. CONCLUSIONS Patients undergoing caudal extension of previous fusions for sagittal alignment correction have high rates of clinical success, low revision surgery rates, and very low rates of PJF. Minimizing repetitive tissue trauma at the UIV may result in decreased PJF risk because the PJF rate in this cohort of patients with unaltered UIV is below historical PJF rates of patients undergoing sagittal balance correction.
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Affiliation(s)
- Alan H Daniels
- Department of Orthopedics, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
| | - Daniel B C Reid
- Department of Orthopedics, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Wesley M Durand
- Department of Orthopedics, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Breton Line
- Department of Orthopedics, Denver International Spine Center, Presbyterian/St. Luke's, Rocky Mountain Hospital for Children, Denver, Colorado, USA
| | - Peter Passias
- Department of Orthopaedics, NYU Langone Medical Center, New York, New York, USA
| | - Han Jo Kim
- Department of Orthopedics, Hospital for Special Surgery, New York, New York, USA
| | | | - Virginie LaFage
- Department of Orthopedics, Hospital for Special Surgery, New York, New York, USA
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | | | - Munish Gupta
- Department of Orthopedics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Eric Klineberg
- Department of Orthopedics, University of California, Davis, California, USA
| | - Frank Schwab
- Department of Orthopedics, Hospital for Special Surgery, New York, New York, USA
| | - Doug Burton
- Department of Orthopedics, University of Kansas Hospital, Kansas City, Kansas, USA
| | - Shay Bess
- Department of Orthopedics, Denver International Spine Center, Presbyterian/St. Luke's, Rocky Mountain Hospital for Children, Denver, Colorado, USA
| | - Christopher Ames
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
| | - Robert A Hart
- Department of Orthopedics, Swedish Medical Center, Seattle, Washington, USA
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Daniels AH, Reid DBC, Durand WM, Hamilton DK, Passias PG, Kim HJ, Protopsaltis TS, Lafage V, Smith JS, Shaffrey CI, Gupta M, Klineberg E, Schwab F, Burton D, Bess S, Ames CP, Hart RA. Upper-thoracic versus lower-thoracic upper instrumented vertebra in adult spinal deformity patients undergoing fusion to the pelvis: surgical decision-making and patient outcomes. J Neurosurg Spine 2020; 32:600-606. [PMID: 31860807 DOI: 10.3171/2019.9.spine19557] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 09/30/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Optimal patient selection for upper-thoracic (UT) versus lower-thoracic (LT) fusion during adult spinal deformity (ASD) correction is challenging. Radiographic and clinical outcomes following UT versus LT fusion remain incompletely understood. The purposes of this study were: 1) to evaluate demographic, radiographic, and surgical characteristics associated with choice of UT versus LT fusion endpoint; and 2) to evaluate differences in radiographic, clinical, and health-related quality of life (HRQOL) outcomes following UT versus LT fusion for ASD. METHODS Retrospective review of a prospectively collected multicenter ASD database was performed. Patients with ASD who underwent fusion from the sacrum/ilium to the LT (T9-L1) or UT (T1-6) spine were compared for demographic, radiographic, and surgical characteristics. Outcomes including proximal junctional kyphosis (PJK), reoperation, rod fracture, pseudarthrosis, overall complications, 2-year change in alignment parameters, and 2-year HRQOL metrics (Lumbar Stiffness Disability Index, Scoliosis Research Society-22r questionnaire, Oswestry Disability Index) were compared after controlling for confounding factors via multivariate analysis. RESULTS Three hundred three patients (169 LT, 134 UT) were evaluated. Independent predictors of UT fusion included greater thoracic kyphosis (odds ratio [OR] 0.97 per degree, p = 0.0098), greater coronal Cobb angle (OR 1.06 per degree, p < 0.0001), and performance of a 3-column osteotomy (3-CO; OR 2.39, p = 0.0351). While associated with longer operative times (ratio 1.13, p < 0.0001) and greater estimated blood loss (ratio 1.31, p = 0.0018), UT fusions resulted in greater sagittal vertical axis improvement (-59.5 vs -41.0 mm, p = 0.0035) and lower PJK rates (OR 0.49, p = 0.0457). No significant differences in postoperative HRQOL measures, reoperation, or overall complication rates were detected between groups (all p > 0.1). CONCLUSIONS Greater deformity and need for 3-CO increased the likelihood of UT fusion. Despite longer operative times and greater blood loss, UT fusions resulted in better sagittal correction and lower 2-year PJK rates following surgery for ASD. While continued surveillance is necessary, this information may inform patient counseling and surgical decision-making.
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Affiliation(s)
- Alan H Daniels
- 1Department of Orthopaedics, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Daniel B C Reid
- 1Department of Orthopaedics, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Wesley M Durand
- 1Department of Orthopaedics, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - D Kojo Hamilton
- 2University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Peter G Passias
- 3Department of Orthopedics, NYU Langone Orthopedic Hospital, New York, New York
| | - Han Jo Kim
- 4Hospital for Special Surgery, New York, New York
| | | | | | - Justin S Smith
- 5University of Virginia Health System, Charlottesville, Virginia
| | | | | | - Eric Klineberg
- 8University of California, Davis, Sacramento, California
| | - Frank Schwab
- 4Hospital for Special Surgery, New York, New York
| | | | - Shay Bess
- 10Denver International Spine Center, Presbyterian/St. Luke's, Denver, Colorado
| | | | - Robert A Hart
- 12Swedish Neuroscience Institute, Seattle, Washington
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Fruergaard S, Jain MJ, Deveza L, Liu D, Heydemann J, Ohrt-Nissen S, Dragsted C, Gehrchen M, Dahl B. Evaluation of a new sagittal classification system in adolescent idiopathic 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 2019; 29:744-753. [PMID: 31802239 DOI: 10.1007/s00586-019-06241-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/21/2019] [Accepted: 11/28/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE The purpose of the present study was to validate a new spinal sagittal classification. METHODS We retrospectively included 105 consecutive AIS patients who underwent posterior spinal fusion. Preoperative long-standing EOS radiographs were available on all patients. Patients were classified according to the four suggested sagittal patterns: type 1, 2a, 2b or 3. Several predetermined sagittal parameters were compared between the groups. RESULTS The mean preoperative Cobb angle was 64° ± 12°, and 73% of the patients were female. Of 105 patients, 51 were type 1, 14 were type 2a, one was type 2b and 39 were type 3. The distribution of the four sagittal patterns was significantly different compared with the original publication (p < 0.05). However, the two study populations were comparable in terms of Lenke and Roussouly types (p = 0.49 and 0.47, respectively). In our study population, the sagittal groups differed significantly in terms of thoracic kyphosis, length of thoracic and lumbar curves, lumbar lordosis, thoracic slope, C7 slope, pelvic incidence and sacral slope (p < 0.05). CONCLUSION The distribution of the four sagittal patterns varies between AIS cohorts. Type 2b was rare, which limits the clinical applicability. Contrary to the original publication, we found that the spinopelvic parameters lumbar lordosis, pelvic incidence and sacral slope were significantly different between the Abelin-Genevois types. Hence, the corrective surgical strategy may need to incorporate these spinopelvic parameters to achieve a balanced spine requiring a minimum of energy expenditure. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Sidsel Fruergaard
- Department of Orthopedics and Scoliosis Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA. .,Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Mohit J Jain
- Department of Orthopedics and Scoliosis Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - Lorenzo Deveza
- Department of Orthopedics and Scoliosis Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - David Liu
- Department of Orthopedics and Scoliosis Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - John Heydemann
- Department of Orthopedics and Scoliosis Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - Søren Ohrt-Nissen
- Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Casper Dragsted
- Department of Orthopedics and Scoliosis Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA.,Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Martin Gehrchen
- Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Benny Dahl
- Department of Orthopedics and Scoliosis Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
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Hayashi K, Boissière L, Guevara-Villazón F, Larrieu D, Núñez-Pereira S, Bourghli A, Gille O, Vital JM, Pellisé F, Sánchez Pérez-Grueso FJ, Kleinstück F, Acaroğlu E, Alanay A, Obeid I. Factors influencing patient satisfaction after adult scoliosis and spinal deformity surgery. J Neurosurg Spine 2019; 31:408-417. [PMID: 31075761 DOI: 10.3171/2019.2.spine181486] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 02/19/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Achieving high patient satisfaction with management is often one of the goals after adult spinal deformity (ASD) surgery. However, literature on associated factors and their correlations with patient satisfaction is limited. The aim of this study was to determine the clinical and radiographic factors independently correlated with patient satisfaction in terms of management at 2 years after surgery. METHODS A multicenter prospective database of ASD surgery was retrospectively reviewed. The demographics, complications, health-related quality of life (HRQOL) subdomains, and radiographic parameters were examined to determine their correlation coefficients with the Scoliosis Research Society-22 questionnaire (SRS-22R) satisfaction scores at 2 years (Sat-2y score). Subsequently, factors determined to be independently associated with low satisfaction (Sat-2y score ≤ 4.0) were used to construct 2 types of multivariate models: one with 2-year data and the other with improvement (score at 2 years - score at baseline) data. RESULTS A total of 422 patients who underwent ASD surgery (mean age 53.1 years) were enrolled. All HRQOL subdomains and several coronal and sagittal radiographic parameters had significantly improved 2 years after surgery. The Sat-2y score was strongly correlated with the SRS-22R self-image (SI)/appearance subdomain (r = 0.64), followed by moderate correlation with subdomains related to standing (r = 0.53), body pain (r = 0.49-0.55), and function (r = 0.41-0.55) at 2 years. Conversely, the correlation between radiographic or demographic parameters with Sat-2y score was weak (r < 0.4). Multivariate analysis to eliminate confounding factors revealed that a worse Oswestry Disability Index (ODI) score for standing (≥ 2 points; OR 4.48) and pain intensity (≥ 2 points; OR 2.07), SRS-22R SI/appearance subdomain (< 3 points; OR 2.70) at 2 years, and a greater sagittal vertical axis (SVA) (> 5 cm; OR 2.68) at 2 years were independent related factors for low satisfaction. According to the other model, a lower improvement in ODI for standing (< 30%; OR 2.68), SRS-22R pain (< 50%; OR 3.25) and SI/appearance (< 50%; OR 2.18) subdomains, and an inadequate restoration of the SVA from baseline (< 2 cm; OR 3.16) were associated with low satisfaction. CONCLUSIONS Self-image, pain, standing difficulty, and sagittal alignment restoration may be useful goals in improving patient satisfaction with management at 2 years after ASD surgery. Surgeons and other medical providers have to take care of these factors to prevent low satisfaction.
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Affiliation(s)
- Kazunori Hayashi
- 1Spine Surgery Unit 1, Bordeaux University Pellegrin Hospital, Bordeaux, France
- 2Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Louis Boissière
- 1Spine Surgery Unit 1, Bordeaux University Pellegrin Hospital, Bordeaux, France
- 3ELSAN, Polyclinique Jean Villar, Bruges, France
| | | | - Daniel Larrieu
- 1Spine Surgery Unit 1, Bordeaux University Pellegrin Hospital, Bordeaux, France
| | | | - Anouar Bourghli
- 5Orthopedic and Spinal Surgery Department, Kingdom Hospital, Riyadh, Saudi Arabia
| | - Olivier Gille
- 1Spine Surgery Unit 1, Bordeaux University Pellegrin Hospital, Bordeaux, France
| | - Jean-Marc Vital
- 1Spine Surgery Unit 1, Bordeaux University Pellegrin Hospital, Bordeaux, France
| | - Ferran Pellisé
- 4Spine Surgery Unit, Vall d'Hebron Hospital, Barcelona, Spain
| | | | | | | | - Ahmet Alanay
- 9Comprehensive Spine Center, Acibadem Maslak Hospital, Istanbul, Turkey
| | - Ibrahim Obeid
- 1Spine Surgery Unit 1, Bordeaux University Pellegrin Hospital, Bordeaux, France
- 3ELSAN, Polyclinique Jean Villar, Bruges, France
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Diebo BG, Shah NV, Boachie-Adjei O, Zhu F, Rothenfluh DA, Paulino CB, Schwab FJ, Lafage V. Adult spinal deformity. Lancet 2019; 394:160-172. [PMID: 31305254 DOI: 10.1016/s0140-6736(19)31125-0] [Citation(s) in RCA: 299] [Impact Index Per Article: 49.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 04/13/2019] [Accepted: 04/15/2019] [Indexed: 12/12/2022]
Abstract
Adult spinal deformity affects the thoracic or thoracolumbar spine throughout the ageing process. Although adolescent spinal deformities taken into adulthood are not uncommon, the most usual causes of spinal deformity in adults are iatrogenic flatback and degenerative scoliosis. Given its prevalence in the expanding portion of the global population aged older than 65 years, the disorder is of growing interest in health care. Physical examination, with a focus on gait and posture, along with radiographical assessment are primarily used and integrated with risk stratification indices to establish optimal treatment planning. Although non-operative treatment is regarded as the first-line response, surgical outcomes are considerably favourable. Global disparities exist in both the assessment and treatment of adults with spinal deformity across countries of varying incomes, which represents an area requiring further investigation. This Seminar presents evidence and knowledge that represent the evolution of data related to spinal deformity in adults over the past several decades.
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Affiliation(s)
- Bassel G Diebo
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Medical Center, New York, NY, USA.
| | - Neil V Shah
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Medical Center, New York, NY, USA
| | | | - Feng Zhu
- Department of Orthopaedic and Traumatology, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Dominique A Rothenfluh
- Division of Spinal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Carl B Paulino
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Medical Center, New York, NY, USA
| | - Frank J Schwab
- Spine Service, Hospital for Special Surgery, New York, NY, USA
| | - Virginie Lafage
- Spine Service, Hospital for Special Surgery, New York, NY, USA
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What Factors Predict the Risk of Proximal Junctional Failure in the Long Term, Demographic, Surgical, or Radiographic?: Results From a Time-dependent ROC Curve. Spine (Phila Pa 1976) 2019; 44:777-784. [PMID: 30540721 DOI: 10.1097/brs.0000000000002955] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective review of prospective multicenter database. OBJECTIVE To identify an optimal set of factors predicting the risk of proximal junctional failure (PJF) while taking the time dependency of PJF and those factors into account. SUMMARY OF BACKGROUND DATA Surgical correction of adult spinal deformity (ASD) can be complex and therefore, may come with high revision rates due to PJF. METHODS Seven hundred sixty-three operative ASD patients with a minimum of 1-year follow-up were included. PJF was defined as any type of proximal junctional kyphosis (PJK) requiring revision surgery. Time-dependent ROC curves were estimated with corresponding Cox proportional hazard models. The predictive abilities of demographic, surgical, radiographic parameters, and their possible combinations were assessed sequentially. The area under the curve (AUC) was used to evaluate models' performance. RESULTS PJF occurred in 42 patients (6%), with a median time to revision of approximately 1 year. Larger preoperative pelvic tilt (PT) (hazard ratio [HR]=1.044, P = 0.034) significantly increased the risk of PJF. With respect to changes in the radiographic parameters at 6-week postsurgery, larger differences in pelvic incidence-lumbar lordosis (PI-LL) mismatch (HR = 0.924, P = 0.002) decreased risk of PJF. The combination of demographic, surgical, and radiographic parameters has the best predictive ability for the occurrence of PJF (AUC = 0.863), followed by demographic along with radiographic parameters (AUC = 0.859). Both models' predictive ability was preserved over time. CONCLUSIONS Over correction increased the risk of PJF. Radiographic along with demographic parameters have shown the approximately equivalent predictive ability for PJF over time as with the addition of surgical parameters. Radiographic rather than surgical factors may be of particular importance in predicting the development of PJF over time. These results set the groundwork for risk stratification and corresponding prophylactic interventions for patients undergoing ASD surgery. LEVEL OF EVIDENCE 4.
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Cecchinato R, Berjano P, Zerbi A, Damilano M, Redaelli A, Lamartina C. Pedicle screw insertion with patient-specific 3D-printed guides based on low-dose CT scan is more accurate than free-hand technique in spine deformity patients: a prospective, randomized clinical trial. 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 2019; 28:1712-1723. [PMID: 31006069 DOI: 10.1007/s00586-019-05978-3] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 03/10/2019] [Accepted: 04/14/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND Screw misplacement incidence can be as high as 15-30% in spine deformity surgery, with possible devastating consequences. Some technical solutions to prevent misplacement require expensive devices. MySpineTM comprises a low-dose CT scan of the patient's spine to build a virtual model of the spine to plan the screw trajectories and a 3D-printed patient-specific guide system to prepare the screw trajectories and to implant the screws in the vertebrae in order to increase reproducibility and safety of the implants. The aim of this open-label, single-center, prospective randomized clinical trial with independent evaluation of outcomes was to compare the accuracy of free-hand insertion of pedicle screws to MySpineTM 3D-printed patient-specific guides. METHODS Twenty-nine patients undergoing surgical correction for spinal deformity were randomized to Group A (pedicle screws implantation with MySpineTM) or Group B (free-hand implantation). Group A received 297 pedicle screws, and Group B 243 screws. Forty-three screws in Group A crossed over to free-hand implantation. Screw position was graded according to Gertzbein in grades 0, A, B or C, with grades 0 or A considered as "safe area." Total fluoroscopy dose and time were compared in six patients of each group. RESULTS Comparing the two study groups, we observed a statistically significant difference between the two groups (p < 0.05), with 96.1% of screws in the "safe area" in Group A versus a 82.9% in Group B. Group-A patients had a mean effective dose of 0.23 mSv compared to 0.82 mSv in Group B. Patient-specific, 3D-printed pedicle screw guides increase safety in a wide spectrum of deformity conditions. In addition, the total radiation dose is reduced, even considering the need of a low-dose preoperative CT for surgical planning. LEVEL OF EVIDENCE I. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
| | - Pedro Berjano
- GSpine4, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Alberto Zerbi
- GSpine4, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Marco Damilano
- GSpine4, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
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Passias PG, Bortz CA, Pierce KE, Segreto FA, Horn SR, Vasquez-Montes D, Lafage V, Brown AE, Ihejirika Y, Alas H, Varlotta C, Ge DH, Shepard N, Oh C, DelSole EM, Jankowski PP, Hockley A, Diebo BG, Vira SN, Sciubba DM, Raad M, Neuman BJ, Gerling MC. Decreased rates of 30-day perioperative complications following ASD-corrective surgery: A modified Clavien analysis of 3300 patients from 2010 to 2014. J Clin Neurosci 2019; 61:147-152. [DOI: 10.1016/j.jocn.2018.10.104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 10/28/2018] [Indexed: 11/24/2022]
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Hori Y, Hoshino M, Inage K, Miyagi M, Takahashi S, Ohyama S, Suzuki A, Tsujio T, Terai H, Dohzono S, Sasaoka R, Toyoda H, Kato M, Matsumura A, Namikawa T, Seki M, Yamada K, Habibi H, Salimi H, Yamashita M, Yamauchi T, Furuya T, Orita S, Maki S, Shiga Y, Inoue M, Inoue G, Fujimaki H, Murata K, Kawakubo A, Kabata D, Shintani A, Ohtori S, Takaso M, Nakamura H. ISSLS PRIZE IN CLINICAL SCIENCE 2019: clinical importance of trunk muscle mass for low back pain, spinal balance, and quality of life-a multicenter cross-sectional study. 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 2019; 28:914-921. [PMID: 30729293 DOI: 10.1007/s00586-019-05904-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 01/26/2019] [Indexed: 12/14/2022]
Abstract
STUDY DESIGN A multicenter cross-sectional study. OBJECTIVES To clarify the relationship of trunk muscle mass with low back pain, spinal sagittal balance, and quality of life. Few reports have investigated the relationship of trunk muscle mass with lumbar spine function and spinal balance, and the clinical significance of trunk muscle mass remains unclear. METHODS Patients attending spinal outpatient clinics at 10 different medical institutions were enrolled in this study. Patient demographics, trunk muscle mass and appendicular skeletal muscle mass (ASM) measured by bioelectrical impedance analysis (BIA), body mass index (BMI), Charlson Comorbidity Index (CCI), the Oswestry Disability Index (ODI), visual analog scale (VAS) for low back pain, sagittal vertical axis (SVA), and EuroQol 5 Dimension (EQ5D) score were investigated. Multivariate nonlinear regression analysis was used to investigate the association of trunk muscle mass with the ODI, VAS score, SVA, and EQ5D score. RESULTS Of 2551 eligible patients, 1738 (mean age 70.2 ± 11.0 years; 781 men and 957 women) were enrolled. Trunk muscle mass was significantly correlated with the ODI, VAS score, SVA, and EQ5D score (P < 0.001) when adjusted for age, sex, BMI, ASM, CCI, and history of lumbar surgery. Patient deterioration was associated with a decrease in trunk muscle mass, and the deterioration accelerated from approximately 23 kg. CONCLUSIONS Trunk muscle mass was significantly associated with the ODI, VAS score, SVA, and EQ5D score. Trunk muscle mass may assume an important role to elucidate and treat lumbar spinal dysfunction and spinal imbalance. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Yusuke Hori
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Masatoshi Hoshino
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan.
| | - Kazuhide Inage
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masayuki Miyagi
- Department of Orthopaedic Surgery, Kitasato University, School of Medicine, Kanagawa, Japan
| | - Shinji Takahashi
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Shoichiro Ohyama
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Akinobu Suzuki
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Tadao Tsujio
- Department of Orthopaedic Surgery, Shiraniwa Hospital, Nara, Japan
| | - Hidetomi Terai
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Sho Dohzono
- Department of Orthopaedic Surgery, Yodogawa Christian Hospital, Osaka, Japan
| | - Ryuichi Sasaoka
- Department of Orthopaedic Surgery, Yodogawa Christian Hospital, Osaka, Japan
| | - Hiromitsu Toyoda
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Minori Kato
- Department of Orthopaedic Surgery, Osaka City General Hospital, Osaka, Japan
| | - Akira Matsumura
- Department of Orthopaedic Surgery, Osaka City General Hospital, Osaka, Japan
| | - Takashi Namikawa
- Department of Orthopaedic Surgery, Osaka City General Hospital, Osaka, Japan
| | - Masahiko Seki
- Department of Orthopaedic Surgery, Shiraniwa Hospital, Nara, Japan
| | - Kentaro Yamada
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Hasibullah Habibi
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Hamidullah Salimi
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Masaomi Yamashita
- Department of Orthopedic Surgery, JCHO Funabashi Central Hospital, Chiba, Japan
| | - Tomonori Yamauchi
- Department of Orthopedic Surgery, Asahi General Hospital, Chiba, Japan
| | - Takeo Furuya
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Sumihisa Orita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Satoshi Maki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yasuhiro Shiga
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masahiro Inoue
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Gen Inoue
- Department of Orthopaedic Surgery, Kitasato University, School of Medicine, Kanagawa, Japan
| | - Hisako Fujimaki
- Department of Orthopaedic Surgery, Kitasato University, School of Medicine, Kanagawa, Japan
| | - Kosuke Murata
- Department of Orthopaedic Surgery, Kitasato University, School of Medicine, Kanagawa, Japan
| | - Ayumu Kawakubo
- Department of Orthopaedic Surgery, Kitasato University, School of Medicine, Kanagawa, Japan
| | - Daijiro Kabata
- Department of Medical Statistics, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Ayumi Shintani
- Department of Medical Statistics, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masashi Takaso
- Department of Orthopaedic Surgery, Kitasato University, School of Medicine, Kanagawa, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
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Arima H, Glassman SD, Dimar JR, Matsuyama Y, Carreon LY. Neurologic Comorbidities Predict Proximal Junctional Failure in Adult Spinal Deformity. Spine Deform 2019; 6:576-586. [PMID: 30122394 DOI: 10.1016/j.jspd.2018.01.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 01/21/2018] [Accepted: 01/27/2018] [Indexed: 10/28/2022]
Abstract
STUDY DESIGN Retrospective case-control matched cohort from a single institution. OBJECTIVE To examine the contribution of nonmechanical factors to the incidence of proximal junctional failure (PJF) after adult spinal deformity (ASD) surgery. SUMMARY OF BACKGROUND DATA Multiple studies have reported on the prevalence of PJF following surgery for ASD. However, little is known about the contribution of nonmechanical factors to the incidence of PJF. METHODS We identified a consecutive series of ASD patients who required revision surgery for PJF between 2013 and 2015. A matched cohort of ASD patients who did not develop PJF after surgical correction was identified based on age, gender, preoperative deformity type, number of fusion levels, and the lower instrumented vertebra level. We compared medical and surgical histories in the matched cohorts, with particular attention to the prevalence of preoperative neurologic comorbidities that might affect standing balance. Preoperative, immediate postoperative, and follow-up radiographs were reviewed to document specific characteristics of mechanical failure that resulted in PJF and required revision surgery. RESULTS Twenty-eight cases of PJF requiring revision surgery were identified. The prevalence rates of preoperative neurologic comorbidities in PJF cohort were significantly higher than in non-PJF cohort (75% vs. 32%, p < .001). Neurologic comorbidities included prior stroke (4), metabolic encephalopathy (2), Parkinson disease (1), seizure disorder (1), cervical and thoracic myelopathy (7), diabetic neuropathy (4), and other neuropathy (4). The mean preoperative sagittal vertical axis in PJF cohort was more positive compared with the non-PJF cohort (144 mm vs. 65 mm, p = .009) There were no significant differences in immediate postoperative or follow-up radiographic parameters between cohorts. CONCLUSIONS In this study, risk factors identified for the development of PJF included nonmechanical neurologic comorbidities, emphasizing the need to look beyond radiographic alignment in order to reduce the incidence of PJF. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- Hideyuki Arima
- Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40204, USA; Department of Orthopaedic Surgery, University of Louisville School of Medicine, 550 S. Jackson Street, 1st Floor ACB, Louisville, KY 40202, USA; Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.
| | - Steven D Glassman
- Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40204, USA; Department of Orthopaedic Surgery, University of Louisville School of Medicine, 550 S. Jackson Street, 1st Floor ACB, Louisville, KY 40202, USA
| | - John R Dimar
- Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40204, USA; Department of Orthopaedic Surgery, University of Louisville School of Medicine, 550 S. Jackson Street, 1st Floor ACB, Louisville, KY 40202, USA
| | - Yukihiro Matsuyama
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Leah Y Carreon
- Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40204, USA
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Diebo BG, Segreto FA, Jalai CM, Vasquez-Montes D, Bortz CA, Horn SR, Frangella NJ, Egers MI, Klineberg E, Lafage R, Lafage V, Schwab F, Passias PG. Baseline mental status predicts happy patients after operative or non-operative treatment of adult spinal deformity. JOURNAL OF SPINE SURGERY 2018; 4:687-695. [PMID: 30713999 DOI: 10.21037/jss.2018.09.11] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background The study is a retrospective review of a multi-institutional database, aiming to determine predictors of non-depressed, satisfied adult spinal deformity (ASD) patients with good self-image at 2-year follow-up (2Y). ASD significantly impacts a patients' psychological status. Following treatment, little is known about predictors of satisfied patients with high self-image and mental status. Methods Inclusion: primary ASD pts >18 y/o with complete 2Y follow-up. Non-depressed [Short Form 36-mental component score (SF36-MCS) >42], satisfied patients (SRS22-satisfaction >3) with good self-image (SR22-self-image >3) at 2Y were isolated (happy). Happy and control patients were propensity-matched by baseline and 2Y leg pain, Charlson, frailty, and radiographic measures for the operative (OP) and non-operative cohorts (NOP). Health related quality of life (HRQL), surgical and radiographic metrics were compared. Regression models identified predictors of happy patients. Thresholds were calculated using area under the curve (AUC) and 95%CI. Results Of 480 patients, 94 OP (happy: 47 vs. control: 47) and 92 NOP (46 each) reached inclusion. At baseline, groups had similar age, gender, Oswestry disability index (ODI) (OP: 39.13 vs. 37.49, NOP: 17.70 vs. 19.74) and SF36-physical component score (PCS) (OP: 33.51 vs. 35.04, NOP: 47.93 vs. 44.72). Despite similar (P>0.05) surgeries, length of stay (LOS), and radiographic outcomes between OP happy and control groups, happy had less peri-operative complications (31.9% vs. 57.4%, P=0.13), better 2Y ODI (17.77 vs. 29.98), SRS22 component, total, and SF36 scores (P<0.05). NOP happy patients also exhibited better 2Y ODI (13.24 vs. 22.09), SRS22 component, total, and SF36 scores (P<0.05). Baseline SRS-mental (OR: 2.199, AUC: 0.617, cutoff: 2.5) and ODI improvement (OR: 1.055, AUC: 0.717, cutoff: >12) predicted happy OP patients, while baseline SRS-self-image (OR: 5.195, AUC: 0.740, cutoff: 3.5) and ODI improvement (OR: 1.087, AUC: 0.683, cutoff: >9) predicted happy NOP patients. Conclusions Baseline mental-status, self-image and ODI improvement significantly impact long-term happiness in ASD patients. Despite equivalent management and alignment outcomes, operative and non-operative happy patients had better 2Y disability scores. Management strategies aimed at improving baseline mental-status, perception-of-deformity, and maximizing ODI may optimize treatment outcomes.
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Affiliation(s)
- Bassel G Diebo
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Frank A Segreto
- Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital-New York Spine Institute, New York, NY, USA
| | - Cyrus M Jalai
- Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital-New York Spine Institute, New York, NY, USA
| | - Dennis Vasquez-Montes
- Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital-New York Spine Institute, New York, NY, USA
| | - Cole A Bortz
- Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital-New York Spine Institute, New York, NY, USA
| | - Samantha R Horn
- Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital-New York Spine Institute, New York, NY, USA
| | - Nicholas J Frangella
- Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital-New York Spine Institute, New York, NY, USA
| | - Max I Egers
- Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital-New York Spine Institute, New York, NY, USA
| | - Eric Klineberg
- Department of Orthopaedic Surgery, University of California, Davis, Davis, CA, USA
| | - Renaud Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Virginie Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Frank Schwab
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Peter G Passias
- Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital-New York Spine Institute, New York, NY, USA
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Kwan KYH, Bow C, Samartzis D, Lenke LG, Shaffrey CI, Carreon LY, 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, Cheung KMC. Non-neurologic adverse events after complex adult spinal deformity surgery: results from the prospective, multicenter Scoli-RISK-1 study. 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 2018; 28:170-179. [DOI: 10.1007/s00586-018-5790-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 09/16/2018] [Accepted: 10/04/2018] [Indexed: 11/30/2022]
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Zhang XN, Sun XY, Hai Y, Meng XL, Wang YS. Incidence and risk factors for multiple medical complications in adult degenerative scoliosis long-level fusion. J Clin Neurosci 2018; 54:14-19. [PMID: 29887273 DOI: 10.1016/j.jocn.2018.04.070] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 03/18/2018] [Accepted: 04/22/2018] [Indexed: 12/21/2022]
Abstract
Adult degenerative scoliosis (ADS) surgery is known for its high incidence of complications. The propose of this study was to determine current complication rates and the predictors of medical complications in surgical ASD patients. A retrospective study of 153 ADS patients who underwent long level spinal fusion with 2-year follow-up between 2012 and 2017. The patient- and surgical-related risk factors for each individual medical complication were identified by using univariate testing. All patients were divided into groups with and without medical complication, infection, neurological complications, and cardiopulmonary complications, respectively. Potential risk factors were identified using univariate testing. Multivariate Logistic regression was used to evaluate independent predictors of medical complications. The total medical complication incidence was 26.1%. Patient-related independent risk factors for the development of medical complications included diabetes, smoking; for infection were diabetes and smoking; for neurological complications were BMI and diabetes; for cardiopulmonary complications were hypertension, smoking and cardiac comorbidity. Surgical-related independent risk factors for the development of medical complications were fusion level, operative time, osteotomy, blood transfusion and LOS; for infection were fusion level, blood transfusion, and LOS; for neurological complication were fusion level, osteotomy and blood transfusion; for cardiopulmonary complication were fusion level. Diabetes and smoking were the most common patient-related independent risk factors increase the development of each individual medical complication. On the other hand, fusion levels and blood transfusion were the most common surgical-related independent risk factors increase the development of each individual medical complication. Prevention of these risk factors can reduce the incidence of complications in Chinese patients with ADS surgery.
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Affiliation(s)
- Xi-Nuo Zhang
- Beijing Chao-Yang Hospital, Capital Medical University, Gongti South Rd No. 8, Beijing, China
| | - Xiang-Yao Sun
- Beijing Chao-Yang Hospital, Capital Medical University, Gongti South Rd No. 8, Beijing, China
| | - Yong Hai
- Beijing Chao-Yang Hospital, Capital Medical University, Gongti South Rd No. 8, Beijing, China.
| | - Xiang-Long Meng
- Beijing Chao-Yang Hospital, Capital Medical University, Gongti South Rd No. 8, Beijing, China
| | - Yun-Sheng Wang
- Beijing Chao-Yang Hospital, Capital Medical University, Gongti South Rd No. 8, Beijing, China
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Frailty and Health-Related Quality of Life Improvement Following Adult Spinal Deformity Surgery. World Neurosurg 2018; 112:e548-e554. [DOI: 10.1016/j.wneu.2018.01.079] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 01/08/2018] [Accepted: 01/11/2018] [Indexed: 11/17/2022]
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Complications in adult spine deformity surgery: a systematic review of the recent literature with reporting of aggregated incidences. 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 2018; 27:2272-2284. [DOI: 10.1007/s00586-018-5535-y] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 01/16/2018] [Accepted: 02/24/2018] [Indexed: 10/17/2022]
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Diebo BG, Shah NV, Stroud SG, Paulino CB, Schwab FJ, Lafage V. Realignment surgery in adult spinal deformity. DER ORTHOPADE 2018; 47:301-309. [DOI: 10.1007/s00132-018-3536-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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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 2018; 42:319-336. [PMID: 29411177 DOI: 10.1007/s10143-018-0951-3] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [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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48
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Bae J, Theologis AA, Strom R, Tay B, Burch S, Berven S, Mummaneni PV, Chou D, Ames CP, Deviren V. Comparative analysis of 3 surgical strategies for adult spinal deformity with mild to moderate sagittal imbalance. J Neurosurg Spine 2017; 28:40-49. [PMID: 29087808 DOI: 10.3171/2017.5.spine161370] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Surgical treatment of adult spinal deformity (ASD) is an effective endeavor that can be accomplished using a variety of surgical strategies. Here, the authors assess and compare radiographic data, complications, and health-related quality-of-life (HRQoL) outcome scores among patients with ASD who underwent a posterior spinal fixation (PSF)-only approach, a posterior approach combined with lateral lumbar interbody fusion (LLIF+PSF), or a posterior approach combined with anterior lumbar interbody fusion (ALIF+PSF). METHODS The medical records of consecutive adults who underwent thoracolumbar fusion for ASD between 2003 and 2013 at a single institution were reviewed. Included were patients who underwent instrumentation from the pelvis to L-1 or above, had a sagittal vertical axis (SVA) of < 10 cm, and underwent a minimum of 2 years' follow-up. Those who underwent a 3-column osteotomy were excluded. Three groups of patients were compared on the basis of the procedure performed, LLIF+PSF, ALIF+PSF, and PSF only. Perioperative spinal deformity parameters, complications, and HRQoL outcome scores (Oswestry Disability Index [ODI], Scoliosis Research Society 22-question Questionnaire [SRS-22], 36-Item Short Form Health Survey [SF-36], visual analog scale [VAS] for back/leg pain) from each group were assessed and compared with each other using ANOVA. The minimal clinically important differences used were -1.2 (VAS back pain), -1.6 (VAS leg pain), -15 (ODI), 0.587/0.375/0.8/0.42 (SRS-22 pain/function/self-image/mental health), and 5.2 (SF-36, physical component summary). RESULTS A total of 221 patients (58 LLIF, 91 ALIF, 72 PSF only) met the inclusion criteria. Average deformities consisted of a SVA of < 10 cm, a pelvic incidence-lumbar lordosis (LL) mismatch of > 10°, a pelvic tilt of > 20°, a lumbar Cobb angle of > 20°, and a thoracic Cobb angle of > 15°. Preoperative SVA, LL, pelvic incidence-LL mismatch, and lumbar and thoracic Cobb angles were similar among the groups. Patients in the PSF-only group had more comorbidities, those in the ALIF+PSF group were, on average, younger and had a lower body mass index than those in the LLIF+PSF group, and patients in the LLIF+PSF group had a significantly higher mean number of interbody fusion levels than those in the ALIF+PSF and PSF-only groups. At final follow-up, all radiographic parameters and the mean numbers of complications were similar among the groups. Patients in the LLIF+PSF group had proximal junctional kyphosis that required revision surgery significantly less often and fewer proximal junctional fractures and vertebral slips. All preoperative HRQoL scores were similar among the groups. After surgery, the LLIF+PSF group had a significantly lower ODI score, higher SRS-22 self-image/total scores, and greater achievement of the minimal clinically important difference for the SRS-22 pain score. CONCLUSIONS Satisfactory radiographic outcomes can be achieved similarly and adequately with these 3 surgical approaches for patients with ASD with mild to moderate sagittal deformity. Compared with patients treated with an ALIF+PSF or PSF-only surgical strategy, patients who underwent LLIF+PSF had lower rates of proximal junctional kyphosis and mechanical failure at the upper instrumented vertebra and less back pain, less disability, and better SRS-22 scores.
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Affiliation(s)
- Junseok Bae
- 1Department of Neurological Surgery, Wooridul Spine Hospital, Seoul, South Korea; and
| | | | | | - Bobby Tay
- Departments of2Orthopaedic Surgery and
| | | | | | | | - Dean Chou
- 3Neurological Surgery, University of California, San Francisco, California
| | - Christopher P Ames
- 3Neurological Surgery, University of California, San Francisco, California
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Usage of Chewing Gum in Posterior Spinal Fusion Surgery for Adolescent Idiopathic Scoliosis: A Randomized Controlled Trial. Spine (Phila Pa 1976) 2017; 42:1427-1433. [PMID: 28248896 DOI: 10.1097/brs.0000000000002135] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Randomized controlled trial. OBJECTIVE The present study investigated the effectiveness of chewing gum on promoting faster bowel function and its ability to hasten recovery for patients with adolescent idiopathic scoliosis (AIS) after posterior spinal fusion (PSF) surgery. SUMMARY OF BACKGROUND DATA Sham feeding with chewing gum had been reported to reduce the incidence of postoperative ileus by accelerating recovery of bowel function. METHODS We prospectively recruited and randomized 60 patients with AIS scheduled for PSF surgery into treatment (chewing gum) and control group. The patient-controlled anesthesia usage, wound pain score, abdominal pain score, nausea score, and abdominal girth were assessed and recorded at 12, 24, 36, 48, and 60 hours postoperatively. The timing for the first fluid intake, first oral intake, sitting up, walking, first flatus after surgery, first bowel opening after surgery, and duration of hospital stay were also assessed and recorded. RESULTS We found that there were no significant differences (P > 0.05) in patient-controlled anesthesia usage, wound pain score, abdominal pain score, nausea score, and abdominal girth between treatment (chewing gum) and control groups. We also found that there were no significant difference (P > 0.05) in postoperative recovery parameters, which were the first fluid intake, first oral intake, sitting up after surgery, walking after surgery, first flatus after surgery, first bowel opening after surgery, and duration of hospital stay between both groups. The wound pain was the worst at 12 hours postoperatively, which progressively improved in both groups. The abdominal pain progressively worsened to the highest score at 48 hours in the treatment group and 36 hours in the control group before improving after that. The pattern of severity and recovery of wound pain and abdominal pain was different. CONCLUSION We found that chewing gum did not significantly reduce the abdominal pain, promote faster bowel function, or hasten patient recovery. LEVEL OF EVIDENCE 1.
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Adult Spinal Deformity: National Trends in the Presentation, Treatment, and Perioperative Outcomes From 2003 to 2010. Spine Deform 2017; 5:342-350. [PMID: 28882352 DOI: 10.1016/j.jspd.2017.02.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 02/10/2017] [Accepted: 02/11/2017] [Indexed: 11/22/2022]
Abstract
STUDY DESIGN Retrospective review of a prospective database. OBJECTIVES To investigate adult spinal deformity (ASD) surgery outcome trends on a nationwide scale using the Nationwide Inpatient Sample (NIS) from 2003 to 2010. METHODS ASD patients ≥25 years from 2003 to 2010 in the NIS undergoing anterior, posterior, or combined surgical approaches were included. Fractures, 9+ levels fused, or any cancer were excluded. Patient demographics, hospital data, and procedure-related complications were evaluated. Yearly trends were analyzed using univariate analysis and linear regression modeling. RESULTS Of 10,966 discharges, 1,952 were anterior, 6,524 were posterior, and 1,106 were combined. The total surgical ASD volume increased by 112.5% (p = .029), and both the average patient age (p < .001) and number of patients >65 years old significantly increased from 2003 to 2010 (p = .009). Anterior approach case volume decreased by 13.7% (p = .019), whereas that of combined increased by 22.7% (p = .047). Posterior case volume increased by 38.9% from 2003 to 2010, though insignificantly (p = .084). Total hospital charges for all approaches increased over the interval (p < .001). Total length of stay for all approaches decreased over the time interval (p < .005). Although the overall morbidity for all approaches increased by 22.7% (p < .001), mortality did not change (p = .817). The most common morbidities in 2003 were hemorrhagic anemia, accidental cut, puncture, perforation, or laceration during a procedure, and device-related complications, which persisted in 2010 with the exception of increased acute respiratory distress syndrome and pulmonary-related complications. CONCLUSIONS For ASD surgery from 2003 to 2010, the volume of anterior approaches decreased, whereas posterior procedures did not change, and combined approaches increased. Total hospital charges increased for all considered procedures, length of hospital stay decreased, whereas operative patients were increasingly elderly, and more procedures were observed for patients >65 years old. For all approaches, morbidity increased whereas mortality did not change. Future study is required to develop methods to reduce morbidity and costs, thereby optimizing patient outcomes.
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