TY - JOUR
T1 - Long-term Morbidity in Patients after Surgical Correction of Adult Spinal Deformity
T2 - Results from a Cohort with Minimum 5-year Follow-up
AU - Imbo, Bailey
AU - Williamson, Tyler
AU - Joujon-Roche, Rachel
AU - Krol, Oscar
AU - Tretiakov, Peter
AU - Ahmad, Salman
AU - Bennett-Caso, Claudia
AU - Schoenfeld, Andrew J.
AU - Dinizo, Michael
AU - De La Garza-Ramos, Rafael
AU - Janjua, M. Burhan
AU - Vira, Shaleen
AU - Ihejirika-Lomedico, Rivka
AU - Raman, Tina
AU - O'Connell, Brooke
AU - Maglaras, Constance
AU - Paulino, Carl
AU - Diebo, Bassel
AU - Lafage, Renaud
AU - Lafage, Virginie
AU - Passias, Peter G.
N1 - Publisher Copyright:
© 2023 Lippincott Williams and Wilkins. All rights reserved.
PY - 2023/8/1
Y1 - 2023/8/1
N2 - Study Design. Retrospective. Objective. The objective of this study is to describe the rate of postoperative morbidity before and after two-year (2Y) follow-up for patients undergoing surgical correction of adult spinal deformity (ASD). Summary of Background Data. Advances in modern surgical techniques for deformity surgery have shown promising short-term clinical results. However, the permanence of radiographic correction, mechanical complications, and revision surgery in ASD surgery remains a clinical challenge. Little information exists on the incidence of long-term morbidity beyond the acute postoperative window. Methods. ASD patients with complete baseline and five-year (5Y) health-related quality of life and radiographic data were included. The rates of adverse events, including proximal junctional kyphosis (PJK), proximal junctional failure (PJF), and reoperations up to 5Y were documented. Primary and revision surgeries were compared. We used logistic regression analysis to adjust for demographic and surgical confounders. Results. Of 118 patients eligible for 5Y follow-up, 99(83.9%) had complete follow-up data. The majority were female (83%), mean age 54.1 years and 10.4 levels fused and 14 undergoing three-column osteotomy. Thirty-three patients had a prior fusion and 66 were primary cases. By 5Y postop, the cohort had an adverse event rate of 70.7% with 25 (25.3%) sustaining a major complication and 26 (26.3%) receiving reoperation. Thirty-eight (38.4%) developed PJK by 5Y and 3 (4.0%) developed PJF. The cohort had a significantly higher rate of complications (63.6% vs. 19.2%), PJK (34.3% vs. 4.0%), and reoperations (21.2% vs. 5.1%) before 2Y, all P<0.01. The most common complications beyond 2Y were mechanical complications. Conclusions. Although the incidence of adverse events was high before 2Y, there was a substantial reduction in longer follow-up indicating complications after 2Y are less common. Complications beyond 2Y consisted mostly of mechanical issues.
AB - Study Design. Retrospective. Objective. The objective of this study is to describe the rate of postoperative morbidity before and after two-year (2Y) follow-up for patients undergoing surgical correction of adult spinal deformity (ASD). Summary of Background Data. Advances in modern surgical techniques for deformity surgery have shown promising short-term clinical results. However, the permanence of radiographic correction, mechanical complications, and revision surgery in ASD surgery remains a clinical challenge. Little information exists on the incidence of long-term morbidity beyond the acute postoperative window. Methods. ASD patients with complete baseline and five-year (5Y) health-related quality of life and radiographic data were included. The rates of adverse events, including proximal junctional kyphosis (PJK), proximal junctional failure (PJF), and reoperations up to 5Y were documented. Primary and revision surgeries were compared. We used logistic regression analysis to adjust for demographic and surgical confounders. Results. Of 118 patients eligible for 5Y follow-up, 99(83.9%) had complete follow-up data. The majority were female (83%), mean age 54.1 years and 10.4 levels fused and 14 undergoing three-column osteotomy. Thirty-three patients had a prior fusion and 66 were primary cases. By 5Y postop, the cohort had an adverse event rate of 70.7% with 25 (25.3%) sustaining a major complication and 26 (26.3%) receiving reoperation. Thirty-eight (38.4%) developed PJK by 5Y and 3 (4.0%) developed PJF. The cohort had a significantly higher rate of complications (63.6% vs. 19.2%), PJK (34.3% vs. 4.0%), and reoperations (21.2% vs. 5.1%) before 2Y, all P<0.01. The most common complications beyond 2Y were mechanical complications. Conclusions. Although the incidence of adverse events was high before 2Y, there was a substantial reduction in longer follow-up indicating complications after 2Y are less common. Complications beyond 2Y consisted mostly of mechanical issues.
KW - 5-year morbidity
KW - adult spinal deformity
KW - complications
KW - reoperations
UR - http://www.scopus.com/inward/record.url?scp=85165220170&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85165220170&partnerID=8YFLogxK
U2 - 10.1097/BRS.0000000000004681
DO - 10.1097/BRS.0000000000004681
M3 - Article
C2 - 37040468
AN - SCOPUS:85165220170
SN - 0362-2436
VL - 48
SP - 1089
EP - 1094
JO - Spine
JF - Spine
IS - 15
ER -