Abstract and Introduction
Abstract
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.
Introduction
With advances in modern surgical techniques,[1,2] adult spinal deformity (ASD) correction has been shown to lead to significant improvement in patient functionality and quality of life.[3,4] However, the durability of ASD surgery remains a clinical challenge,[5,6] and has been associated with high rates of intraoperative and postoperative complications.[7–9]
As complications related to ASD surgery are correlated with worse patient outcomes and satisfaction,[10,11] understanding them can lead to improvement in care. Prior studies have largely focused on adverse events and postoperative morbidity within the first two years (2Y) after ASD surgery.[12–14] However, there is concern that patients undergoing ASD surgery may have a longer event horizon for postoperative morbidity, with the risk of adverse events and mechanical failure extending well beyond the first few years after surgery. The current literature is very limited with respect to surveillance of postsurgical adverse events beyond the first 2Yof ASD corrective surgery.
In this context, we used prospectively collected data from a single center to evaluate longer term postoperative morbidity following ASD correction, up to five-years (5Y) after the procedure. At the time of this writing, this database represents one of the largest and most comprehensive spinal deformity data sets available. The means of patient enrollment and data collection have been described in previous work[15,16] and its data have been used to study both clinical and health policy aspects of adult deformity surgery in prior studies. We evaluated the natural history of postoperative adverse events in this cohort, stratifying patients based on whether the index procedure at our institution a primary surgery was or a revision of prior fusion.
Spine. 2023;48(15):1089-1094. © 2023 Lippincott Williams & Wilkins
