Evolution in Surgical Approach, Complications, and Outcomes in an Adult Spinal Deformity Surgery Multicenter Study Group Patient Population.

Published

Journal Article

STUDY DESIGN: Retrospective review of a prospectively collected multicenter database. OBJECTIVES: To evaluate the evolution of surgical treatment strategies, complications, and patient-reported outcomes for adult spinal deformity (ASD) patients. ASD surgery is associated with high complication rates. Evolving treatment strategies may reduce these risks. METHODS: Adult patients undergoing ASD surgery from 2009 to 2016 were analyzed (n = 905). Preoperative and surgical parameters were compared across years. Subgroup analysis of 436 patients with minimum two-year follow-up was also performed. RESULTS: From 2009 to 2016, there was a significant increase in the mean preoperative age (52 to 63.1, p < .001), body mass index (26.3 to 32.2, p = .003), Charlson Comorbidity index (1.4 to 2.2, p < .001), rate of previous spine surgery (39.8% to 53.1%, p = .01), and baseline disability (visual analog scale [VAS] back and leg pain) scores (p < .01), Oswestry Disability Index, and 22-item Scoliosis Research Society Questionnaire scores (p < .001). Preoperative Schwab sagittal alignment modifiers and overall surgical invasiveness index were similar across time. Three-column osteotomy utilization decreased from 36% in 2011 to 16.7% in 2016. Lateral lumbar interbody fusion increased from 6.4% to 24.1% (p = .004), anterior lumbar interbody fusion decreased from 22.9% to 16.7% (p = .043), and transforaminal lumbar interbody fusion/posterior lumbar interbody fusion utilization remained similar (p = .448). Use of recombinant human bone morphogenetic protein-2 (rhBMP-2) in 2012 was 84.6%, declined to 58% in 2013, and rebounded to 76.3% in 2016 (p = .006). Tranexamic acid use increased rapidly from 2009 to 2016 (13.3% to 48.6%, p < .001). Two-year follow-up sagittal vertical axis, pelvic tilt, pelvic incidence-lumbar lordosis, and maximum Cobb angles were similar across years. Intraoperative complications decreased from 33% in 2010 to 9.3% in 2016 (p < .001). Perioperative ( < 30 days, < 90 days) complications peaked in 2010 (42.7%, 46%) and decreased by 2016 (24.1%, p < .001; 29.6%, p = .007). The overall complication rate decreased from 73.2% in 2008-2014 patients to 62.6% in 2015-2016 patients (p = .03). Two-year health-related quality of life outcomes did not significantly differ across the years (p > .05). CONCLUSIONS: From 2009 to 2016, despite an increasingly elderly, medically compromised, and obese patient population, complication rates decreased. Evolving strategies may result in improved treatment of ASD patients. LEVEL OF EVIDENCE: Level IV.

Full Text

Duke Authors

Cited Authors

  • Daniels, AH; Reid, DBC; Tran, SN; Hart, RA; Klineberg, EO; Bess, S; Burton, D; Smith, JS; Shaffrey, C; Gupta, M; Ames, CP; Hamilton, DK; LaFage, V; Schwab, F; Eastlack, R; Akbarnia, B; Kim, HJ; Kelly, M; Passias, PG; Protopsaltis, T; Mundis, GM; International Spine Study Group,

Published Date

  • May 2019

Published In

Volume / Issue

  • 7 / 3

Start / End Page

  • 481 - 488

PubMed ID

  • 31974836

Pubmed Central ID

  • 31974836

Electronic International Standard Serial Number (EISSN)

  • 2212-1358

Digital Object Identifier (DOI)

  • 10.1016/j.jspd.2018.09.013

Language

  • eng

Conference Location

  • England