Long-term complications in adult spinal deformity patients having combined surgery a comparison of primary to revision patients.

STUDY DESIGN: This is a comparison of primary (N = 18) to revision (N = 26) combined (anterior and posterior surgery) adult spinal deformity patients with regard to late (>6 months) complications and radiographic/functional outcomes at a minimum 2-year follow-up. OBJECTIVES: To determine whether revision status increases the risk of late complications or offers a poor prognosis for functional outcome in adult deformity patients. SUMMARY OF BACKGROUND DATA: It is known that patients who have combined surgery for adult deformity have a high incidence of perioperative complications. Long-term complications and the effect of revision status have not been clarified in the literature. The functional outcomes for these patients are unclear as to whether or not there is a difference between primary and revision patients. Outside the arena of adult spinal deformity the functional outcomes for revision cases have been disappointing. METHODS: A consecutive series of 44 patients who underwent combined procedures for adult spinal deformity were followed for a minimum of 2 years (average follow-up 42 months). Clinical data were obtained by chart and radiographic review. Major complications were considered to be deep wound infection, pseudarthrosis, transition syndrome, neurologic deficit, and death. Minor complications considered were asymptomatic instrumentation failure (without loss of correction), instrumentation prominence requiring removal, and proximal or distal junctional segmental kyphosis (5-10 degrees ) or subsequent disc space narrowing of 2-5 mm without clinical symptoms. The patients also completed the AAOS Lumbar/Scoliosis MODEMS questionnaires aimed at assessing pain, function, and satisfaction. RESULTS: Minor complications were comparable in both groups: 4 of 18 (22%) in the primary group and 6 of 26 (23%) in the revision group. Major complications were slightly more frequent in the primary group with five complications in 4 patients (4 of 18 patients) (22%) compared with 3 of 26 patients (12%) in the revision group. The incidence of pseudarthrosis was 22% (4 of 18) for the primary group and 4% (1 of 26) for the revision group (P< 0.14). Forty of 44 patients completed the questionnaires. The primary patients functioned at a slightly higher level after surgery than the revision group. The level of pain was also slightly lower at final follow-up in the primary group. Despite these differences, the revision group had a higher level of patient satisfaction. CONCLUSION: At a minimum 2-year follow-up the late complications were not higher in the revision patients than in the primary group. The rate of major long-term complications, specifically pseudarthroses, was higher in the primary group. Patient satisfaction was higher in the revision patients, probably because they were experiencing a greater level of perceived pain and dysfunction at the time of their reconstruction.

A prospective evaluation of pulmonary function in patients with adolescent idiopathic scoliosis relative to the surgical approach used for spinal arthrodesis.

STUDY DESIGN: A prospective evaluation of pulmonary function in patients with adolescent idiopathic scoliosis undergoing surgical correction. OBJECTIVES: 1) To evaluate prospectively, at regular intervals, the changes in pulmonary function after surgical arthrodesis of primary thoracic and double primary thoracic-lumbar (double major) types of adolescent idiopathic scoliosis in a homogeneous population; 2) to compare the changes in pulmonary function after surgical correction relative to the surgical approach used for spinal arthrodesis; and 3) to determine if short- to midterm morbidity with respect to pulmonary function is associated with the type of surgical approach used for spinal arthrodesis. SUMMARY OF BACKGROUND DATA: The effect of surgical correction on the pulmonary function of patients with adolescent idiopathic scoliosis is controversial. Studies have shown improvement, decline, or no change in pulmonary function after surgical correction of idiopathic scoliosis. METHODS: Ninety-eight patients with adolescent idiopathic scoliosis undergoing surgical treatment at the authors' institution were prospectively evaluated with pulmonary function tests assessing volume (forced vital capacity and total lung capacity) and flow (forced expiratory volume in 1 second). Pulmonary functions were evaluated before surgery and after surgery at 3 months, 1 year, 2 years, and at the final follow-up visit. All patients were divided into four groups depending on the surgical approach used for spinal fusion: Group 1 (n = 47) underwent a posterior spinal fusion with iliac crest bone graft; Group 2 (n = 33) underwent a posterior spinal fusion with rib resection thoracoplasty; Group 3 (n = 7) underwent an anterior spinal fusion with a rib resection thoracotomy; and Group 4 (n = 11) underwent a combined anterior and posterior spinal fusion with autogenous rib and iliac crest graft used, respectively. RESULTS: Patients in Group 1 had improved pulmonary function values at 3 months after surgery, whereas patients in Groups 2, 3, and 4 showed a decline at 3 months after surgery. Two years after surgery, Group 1 had significantly improved pulmonary function values (P < 0.0001), whereas the pulmonary function values of patients in Groups 2, 3, and 4 had returned to preoperative values. CONCLUSIONS: 1) Patients with chest cage disruption during surgical treatment showed a decline in pulmonary function at 3 months after surgery. 2) In contrast, patients without chest cage disruption showed an improvement in pulmonary function at 3 months after surgery. 3) Irrespective of the surgical approach used for spinal arthrodesis, postoperative pulmonary function tests (absolute values) returned to preoperative values at 2 years after surgery. 4) Patients who had no chest cage disruption experienced a significantly greater improvement in two of their pulmonary function values at 2 years after surgery than patients with chest cage disruption.

Complications in the adult spinal deformity patient having combined surgery. Does revision increase the risk?

STUDY DESIGN: A comparison of short-term complications (within 6 months after surgery) between primary combined adult spinal deformity (multilevel scoliosis, kyphosis, fixed coronal-sagittal imbalance) surgeries (n = 18) and combined adult spinal deformity revision surgeries (n = 26). OBJECTIVES: To analyze the short-term complications and to determine whether revision status increases the risks of short-term complications in this group of patients. SUMMARY OF BACKGROUND DATA: There is no peer-reviewed article comparing complications of revision to those in primary patients in a group of patients undergoing combined surgery for adult spinal deformity. METHODS: Major and minor complications were analyzed for both patient groups, and demographic data were collected. The demographic data of the two groups were very similar. RESULTS: The major (11.1% vs. 7.8%) and minor (11.1% vs. 11.5%) complications for the two groups (primary vs. revision) were very similar. All patients had combined procedures and all were patients with adult spinal deformity. The wound complications were less in those receiving total parenteral nutrition (2 of 31) than in those without (2 of 13). The group receiving parenteral nutrition was thought to be at higher risk for wound complications. CONCLUSIONS: The risk of major and minor complications within the first 6 months after surgery is not necessarily greater in the revision group than in the primary group of patients with adult spinal deformity who have combined surgeries. Total parenteral nutrition does appear to have a role in many of these patients.