Preoperative functional status as a predictor of short-term outcome in adult spinal deformity surgery.

Adult spinal deformity (ASD) may cause severe disability and difficulty with daily activities. The purpose of this study was to investigate the impact of preoperative functional status on 30-day major complication occurrence in ASD surgery. A review of the prospectively-collected American College of Surgeons National Surgical Quality Improvement database was performed for the years 2007-2013. Inclusion criteria were adult patients (over 21years of age) who underwent spinal fusion for ASD. Functional status was defined as "independent" or "dependent" (requiring assistance from another person) for activities of daily living such as bathing, dressing, feeding, toileting, or mobility. The association between functional status and complications (overall and major) was investigated via multivariate analysis. Results are presented as odds ratios (OR) with 95% confidence intervals (CI). A total of 1247 patients met inclusion criteria (94.4% independent and 5.6% dependent patients). The overall 30-day complication rate was 16.0% (15.6% for independent patients and 22.9% for dependent patients, p=0.10); major complications occurred in 9.2% of independent patients and 17.1% for dependent patients (p=0.02). After controlling for patient age, smoking status, preoperative hematocrit, revision status, use of osteotomy, number of levels fused, and operative time, being dependent on another person for activities of daily living was found to be a significant predictor of major complication development (OR 2.09; 95% CI, 1.04-4.20; p=0.03). Depending on others for activities of daily living before undergoing ASD surgery may predict the development of major perioperative complications, increasing the risk by 2-fold compared to independent patients.

Clinical outcomes following sublaminar decompression and instrumented fusion for lumbar degenerative spinal pathology.

Traditional treatment for lumbar stenosis with instability is laminectomy and posterolateral arthrodesis, with or without interbody fusion. However, laminectomies remove the posterior elements and decrease the available surface area for fusion. Therefore, a sublaminar decompression may be a preferred approach for adequate decompression while preserving bone surface area for fusion. A retrospective review of 71 patients who underwent sublaminar decompression in conjunction with instrumented fusion for degenerative spinal disorders at a single institution was performed. Data collected included demographics, preoperative symptoms, operative data, and radiographical measurements of the central canal, lateral recesses, and neural foramina, and fusion outcomes. Paired t-tests were used to test significance of the outcomes. Thirty-one males and 40 females with a median age 60years underwent sublaminar decompression and fusion. A median of two levels were fused. The mean Visual Analog Scale pain score improved from 6.7 preoperatively to 2.9 at last follow-up. The fusion rate was 88%, and the median time to fusion was 11months. Preoperative and postoperative mean thecal sac cross-sectional area, right lateral recess height, left lateral recess height, right foraminal diameter, and left foraminal diameter were 153 and 209mm(2) (p<0.001), 5.9 and 5.9mm (p=0.43), 5.8 and 6.3mm (p=0.027), 4.6 and 5.2mm (p=0.008), and 4.2 and 5.2mm (p<0.001), respectively. Sublaminar decompression provided adequate decompression, with significant increases in thecal sac cross-sectional area and bilateral foraminal diameter. It may be an effective alternative to laminectomy in treating central and foraminal stenosis in conjunction with instrumented fusion.