Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Meta-Anal. Dec 26, 2017; 5(6): 132-149
Published online Dec 26, 2017. doi: 10.13105/wjma.v5.i6.132
Different types of mechanical complications after surgical correction of adult spine deformity with osteotomy
Cameron Barton, Andriy Noshchenko, Vikas V Patel, Christopher M J Cain, Christopher Kleck, Evalina L Burger
Cameron Barton, Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA 52242, United States
Andriy Noshchenko, Vikas V Patel, Christopher M J Cain, Christopher Kleck, Evalina L Burger, Department of Orthopedics, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045, United States
Author contributions: Barton C substantial contributions to conception and design of the study, acquisition of data, and drafting of the article; Noshchenko A provided statistical analysis and interpretation of the obtained results, drafting the article; Patel VV, Cain CMJ and Kleck C contributed equally to this work making critical revisions related to important intellectual content of the manuscript; Burger LE provided data quality control, critical revision of the manuscript and final approval of the version of the article to be published.
Supported by Medicrea (New York, NY 10013, United States).
Institutional review board statement: The study was reviewed and approved by the Colorado Multiple Institutional Review Board (COMIRB), Protocol #12-1458.
Informed consent statement: Specific consent was not applicable due to the retrospective design of the study; personal data of the patients were not collected for the study.
Conflict-of-interest statement: Barton C, Medicrea (financial support); Noshchenko A, NIH (Grant/Research Support); Patel VV, Medtronic, SI-bone, NIH (Grants/Research Support), Aesculap and SI-Bone (Consultant); Cain CMJ, DePuy, Synthes, and AOSpine (Consultant); Kleck C, Synthes (Research Support); Burger EL, Medicrea (Consultant), DePuy, Synthes (Grants/Research Support).
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Andriy Noshchenko, PhD, Department of Orthopedics, University of Colorado, Anschutz Medical Campus, 13001 E 17, Building 500, Mail Stop 432, Aurora, CO 80045, United States. andriy.noshchenko@ucdenver.edu
Telephone: +1-303-2586448 Fax: +1-303-7240919
Received: September 15, 2017
Peer-review started: September 16, 2017
First decision: November 7, 2017
Revised: November 21, 2017
Accepted: December 3, 2017
Article in press: December 3, 2017
Published online: December 26, 2017
Abstract
AIM

To determine the incidence and risk factors for mechanical complications (MC) after surgical correction of adult spinal deformity (ASD) with osteotomy.

METHODS

A retrospective study was performed. Inclusion criteria: Surgical correction of ASD using osteotomy; male or female; > 20 years old; follow-up ≥ 24 mo or revision. The MC of spine and spinal instrumentation were studied separately. Risk analysis included assessment of the association between more than 50 different characteristics (demographic, clinical, radiographic, and instrumentation) with different types of MC.

RESULTS

The medical records of 94 operations in 88 subjects were analyzed: Female (68%), mean age 58.6 (SD, 12.7) years. Cumulative incidence of MC at 2 year follow-up was 43.6%. Of these, 78% required revision (P < 0.001). The following characteristics had significant (P ≤ 0.05) association with MC: (1) Preoperative: osteoporosis, smoking, previous spinal operation, sagittal vertical axis (SVA) > 100 mm, lumbar lordosis (LL) < 34°; (2) postoperative: SVA > 75 mm; operative correction: SVA > 75 mm, LL > 30°, thoracic kyphosis > 25°, and pelvic tilt > 9°; a fall; pseudarthrosis; and (3) device and surgical technique: use of previously implanted instrumentation; use of domino and/or parallel connectors; type of osteotomy (PSO vs SPO) if preoperative SVA < 100 mm; lumbar osteotomy location; in-situ rod contouring > 60°; and fixation to sacrum/pelvis.

CONCLUSION

Risk of MC after surgical correction of ASD is substantial. To decrease this risk over- and/or insufficient correction of the sagittal imbalance should be avoided.

Keywords: Adult spinal deformity, Osteotomy, Risk factors, Mechanical complications

Core tip: The main study goal was evaluation of incidence and risk factors for different mechanical complications (MC) after surgical correction of adult spine deformity with osteotomy. Around half of patients experienced complications during two postoperative years; 78% of these cases required additional surgery. MC of spine occurred earlier and more often required revision than the MC of spinal instrumentation. The main risk factors for MC included severe preoperative sagittal imbalance, inadequate correction of the spinopelvic alignment, preoperative comorbidities (osteoporosis), postoperative events (falls), and features of the spinal instrumentation.