Major complications in revision adult deformity surgery

Risk factors and clinical outcomes with 2- to 7-year follow-up

Samuel K. Cho, Keith H. Bridwell, Lawrence G. Lenke, Jin Seok Yi, Joshua M. Pahys, Lukas P. Zebala, Matthew M. Kang, Woojin Cho, Christine R. Baldus

Research output: Contribution to journalArticle

108 Citations (Scopus)

Abstract

Study Design.: Retrospective cohort comparative study. Objective.: To determine the prevalence of major complications, identify risk factors, and assess long-term clinical benefit after revision adult spinal deformity surgery. Summary of Background Data.: No study has analyzed risk factors for major complications in long revision fusion surgery and whether or not occurrence of a major complication affects ultimate clinical outcome. Methods.: Analysis of consecutive adult patients who underwent multilevel revision surgery for spinal deformity with a minimum 2-year follow-up was performed. All complications were classified as either major or minor. Outcome analysis was conducted with the Scoliosis Research Society and Oswestry Disability Index scores. Results.: A total of 166 patients (mean age = 53.8 years) were identified with a mean follow-up of 3.5 years (range: 2-7). Primary diagnoses included idiopathic/de novo scoliosis (107), degenerative (35), trauma (7), neuromuscular scoliosis (6), congenital deformity (5), ankylosing spondylitis (2), tumor (2), Scheuermann kyphosis (1), and rheumatoid arthritis (1). Most common secondary diagnoses that necessitated revision surgery were adjacent segment disease, fixed sagittal imbalance, and pseudarthrosis. Overall, 34.3% of patients developed major complications (19.3% perioperative; 18.7% follow-up). Associated risk factors for perioperative complications were patient- (age > 60 years, medical comorbidities, obesity) and surgery-related (pedicle subtraction osteotomy). Performance of a 3-column osteotomy and postoperative radiographic changes that suggested progressive loss of sagittal correction were recognized as risk factors for follow-up complications. Equivalent outcome scores were reported by patients preoperatively, but those experiencing follow-up complications reported lower scores at the final follow-up. Conclusion.: Overall, 34.4% of patients experienced major complications after long revision fusion surgery. Different risk factors were identified for perioperative versus follow-up complications. The occurrence of a follow-up, not but perioperative, major complication seemed to have a negative impact on ultimate clinical outcome.

Original languageEnglish (US)
Pages (from-to)489-500
Number of pages12
JournalSpine
Volume37
Issue number6
DOIs
StatePublished - Mar 15 2012
Externally publishedYes

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Reoperation
Scoliosis
Osteotomy
Scheuermann Disease
Pseudarthrosis
Ankylosing Spondylitis
Comorbidity
Rheumatoid Arthritis
Cohort Studies
Obesity
Wounds and Injuries
Research
Neoplasms

Keywords

  • clinical outcomes
  • major complications
  • revision surgery
  • risk factors

ASJC Scopus subject areas

  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this

Cho, S. K., Bridwell, K. H., Lenke, L. G., Yi, J. S., Pahys, J. M., Zebala, L. P., ... Baldus, C. R. (2012). Major complications in revision adult deformity surgery: Risk factors and clinical outcomes with 2- to 7-year follow-up. Spine, 37(6), 489-500. https://doi.org/10.1097/BRS.0b013e3182217ab5

Major complications in revision adult deformity surgery : Risk factors and clinical outcomes with 2- to 7-year follow-up. / Cho, Samuel K.; Bridwell, Keith H.; Lenke, Lawrence G.; Yi, Jin Seok; Pahys, Joshua M.; Zebala, Lukas P.; Kang, Matthew M.; Cho, Woojin; Baldus, Christine R.

In: Spine, Vol. 37, No. 6, 15.03.2012, p. 489-500.

Research output: Contribution to journalArticle

Cho, SK, Bridwell, KH, Lenke, LG, Yi, JS, Pahys, JM, Zebala, LP, Kang, MM, Cho, W & Baldus, CR 2012, 'Major complications in revision adult deformity surgery: Risk factors and clinical outcomes with 2- to 7-year follow-up', Spine, vol. 37, no. 6, pp. 489-500. https://doi.org/10.1097/BRS.0b013e3182217ab5
Cho, Samuel K. ; Bridwell, Keith H. ; Lenke, Lawrence G. ; Yi, Jin Seok ; Pahys, Joshua M. ; Zebala, Lukas P. ; Kang, Matthew M. ; Cho, Woojin ; Baldus, Christine R. / Major complications in revision adult deformity surgery : Risk factors and clinical outcomes with 2- to 7-year follow-up. In: Spine. 2012 ; Vol. 37, No. 6. pp. 489-500.
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abstract = "Study Design.: Retrospective cohort comparative study. Objective.: To determine the prevalence of major complications, identify risk factors, and assess long-term clinical benefit after revision adult spinal deformity surgery. Summary of Background Data.: No study has analyzed risk factors for major complications in long revision fusion surgery and whether or not occurrence of a major complication affects ultimate clinical outcome. Methods.: Analysis of consecutive adult patients who underwent multilevel revision surgery for spinal deformity with a minimum 2-year follow-up was performed. All complications were classified as either major or minor. Outcome analysis was conducted with the Scoliosis Research Society and Oswestry Disability Index scores. Results.: A total of 166 patients (mean age = 53.8 years) were identified with a mean follow-up of 3.5 years (range: 2-7). Primary diagnoses included idiopathic/de novo scoliosis (107), degenerative (35), trauma (7), neuromuscular scoliosis (6), congenital deformity (5), ankylosing spondylitis (2), tumor (2), Scheuermann kyphosis (1), and rheumatoid arthritis (1). Most common secondary diagnoses that necessitated revision surgery were adjacent segment disease, fixed sagittal imbalance, and pseudarthrosis. Overall, 34.3{\%} of patients developed major complications (19.3{\%} perioperative; 18.7{\%} follow-up). Associated risk factors for perioperative complications were patient- (age > 60 years, medical comorbidities, obesity) and surgery-related (pedicle subtraction osteotomy). Performance of a 3-column osteotomy and postoperative radiographic changes that suggested progressive loss of sagittal correction were recognized as risk factors for follow-up complications. Equivalent outcome scores were reported by patients preoperatively, but those experiencing follow-up complications reported lower scores at the final follow-up. Conclusion.: Overall, 34.4{\%} of patients experienced major complications after long revision fusion surgery. Different risk factors were identified for perioperative versus follow-up complications. The occurrence of a follow-up, not but perioperative, major complication seemed to have a negative impact on ultimate clinical outcome.",
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