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Evaluation of complications and neurological deficits with three-column spine reconstructions for complex spinal deformity: a retrospective Scoli-RISK-1 study.

Publication ,  Journal Article
Kelly, MP; Lenke, LG; Shaffrey, CI; Ames, CP; Carreon, LY; Lafage, V; Smith, JS; Shimer, AL
Published in: Neurosurg Focus
May 2014

OBJECT: The goal in this study was to evaluate the risk factors for complications, including new neurological deficits, in the largest cohort of patients with adult spinal deformity to date. METHODS: The Scoli-RISK-1 inclusion criteria were used to identify eligible patients from 5 centers who were treated between June 1, 2009, and June 1, 2011. Records were reviewed for patient demographic information, surgical data, and reports of perioperative complications. Neurological deficits were recorded as preexisting or as new deficits. Patients who underwent 3-column osteotomies (3COs) were compared with those who did not (posterior spinal fusion [PSF]). Between-group comparisons were performed using independent samples t-tests and chi-square analyses. RESULTS: Two hundred seven patients were identified-75 who underwent PSF and 132 treated with 3CO. In the latter group, patients were older (58.9 vs 49.4 years, p < 0.001), had a higher body mass index (29.0 vs 25.8, p = 0.029), smaller preoperative coronal Cobb measurements (33.8° vs 56.4°, p < 0.001), more preoperative sagittal malalignment (11.7 cm vs 5.4 cm, p < 0.001), and similar sagittal Cobb measurements (45.8° vs 57.7°, p = 0.113). Operating times were similar (393 vs 423 minutes, p = 0.130), although patients in the 3CO group sustained higher estimated blood loss (2120 vs 1700 ml, p = 0.066). Rates of new neurological deficits were similar (PSF: 6.7% vs 3CO: 9.9%, p = 0.389), and rates of any perioperative medical complication were similar (PSF: 46.7% vs 3CO: 50.8%, p = 0.571). Patients who underwent vertebral column resection (VCR) were more likely to sustain medical complications than those treated with pedicle subtraction osteotomy (73.7% vs 46.9%, p = 0.031), although new neurological deficits were similar (15.8% vs 8.8%, p = 0.348). Regression analysis did not reveal significant predictors of neurological injury or complication from collected data. CONCLUSIONS: Despite higher estimated blood loss, rates of all complications (49.3%) and new neurological deficits (8.7%) did not vary for patients who underwent complex reconstruction, whether or not a 3CO was performed. Patients who underwent VCR sustained more medical complications without an increase in new neurological deficits. Prospective studies of patient factors, provider factors, and refined surgical data are needed to define and optimize risk factors for complication and neurological deficits.

Duke Scholars

Published In

Neurosurg Focus

DOI

EISSN

1092-0684

Publication Date

May 2014

Volume

36

Issue

5

Start / End Page

E17

Location

United States

Related Subject Headings

  • Spinal Fusion
  • Scoliosis
  • Risk Factors
  • Retrospective Studies
  • Postoperative Complications
  • Neurosurgical Procedures
  • Neurology & Neurosurgery
  • Middle Aged
  • Male
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Kelly, M. P., Lenke, L. G., Shaffrey, C. I., Ames, C. P., Carreon, L. Y., Lafage, V., … Shimer, A. L. (2014). Evaluation of complications and neurological deficits with three-column spine reconstructions for complex spinal deformity: a retrospective Scoli-RISK-1 study. Neurosurg Focus, 36(5), E17. https://doi.org/10.3171/2014.2.FOCUS1419
Kelly, Michael P., Lawrence G. Lenke, Christopher I. Shaffrey, Christopher P. Ames, Leah Y. Carreon, Virginie Lafage, Justin S. Smith, and Adam L. Shimer. “Evaluation of complications and neurological deficits with three-column spine reconstructions for complex spinal deformity: a retrospective Scoli-RISK-1 study.Neurosurg Focus 36, no. 5 (May 2014): E17. https://doi.org/10.3171/2014.2.FOCUS1419.
Kelly MP, Lenke LG, Shaffrey CI, Ames CP, Carreon LY, Lafage V, et al. Evaluation of complications and neurological deficits with three-column spine reconstructions for complex spinal deformity: a retrospective Scoli-RISK-1 study. Neurosurg Focus. 2014 May;36(5):E17.
Kelly, Michael P., et al. “Evaluation of complications and neurological deficits with three-column spine reconstructions for complex spinal deformity: a retrospective Scoli-RISK-1 study.Neurosurg Focus, vol. 36, no. 5, May 2014, p. E17. Pubmed, doi:10.3171/2014.2.FOCUS1419.
Kelly MP, Lenke LG, Shaffrey CI, Ames CP, Carreon LY, Lafage V, Smith JS, Shimer AL. Evaluation of complications and neurological deficits with three-column spine reconstructions for complex spinal deformity: a retrospective Scoli-RISK-1 study. Neurosurg Focus. 2014 May;36(5):E17.

Published In

Neurosurg Focus

DOI

EISSN

1092-0684

Publication Date

May 2014

Volume

36

Issue

5

Start / End Page

E17

Location

United States

Related Subject Headings

  • Spinal Fusion
  • Scoliosis
  • Risk Factors
  • Retrospective Studies
  • Postoperative Complications
  • Neurosurgical Procedures
  • Neurology & Neurosurgery
  • Middle Aged
  • Male
  • Humans