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Chen JW, Chanbour H, Gupta R, Izah J, Vaughan WE, Abtahi AM, Zuckerman SL, Stephens BF. Adult versus adolescent idiopathic scoliosis surgery: a meta-analysis of clinical and radiographic outcomes. Eur Spine J 2024; 33:1637-1643. [PMID: 38436875 DOI: 10.1007/s00586-024-08177-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 12/31/2023] [Accepted: 01/31/2024] [Indexed: 03/05/2024]
Abstract
INTRODUCTION While the natural history of adolescent idiopathic scoliosis (AIS) and adult idiopathic scoliosis (AdIS) is well documented in the literature, the impact of age on postoperative outcomes remains an active area of research. We performed a systematic review and meta-analysis to compare patients undergoing surgery for AIS and AdIS with respect to: (1) postoperative Cobb correction, (2) perioperative variables, and (3) postoperative complications. METHODS A systematic literature search was performed in accordance with preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. INCLUSION CRITERIA studies published between 2002 and 2022, retrospective, and comparing AIS vs. AdIS patients undergoing deformity surgery. The primary outcome was postoperative Cobb correction. Secondary outcomes included estimated blood loss (EBL), operative time, total instrumented levels, length of stay (LOS), and postoperative complications. Random-effects models were performed according to the method of DerSimonian and Laird. RESULTS Of 190 identified articles, 14 fit the inclusion criteria. A total of 1788 patients were included, 1275(71.3%) with AIS, and 513(28.7%) with AdIS. There was a significant age difference between AIS and AdIS (15.3 vs. 36.7 years, mean difference (MD) = 21.3 years, 95%CI = 14.3-28.4,p < 0.001). Mean postoperative Cobb percentage correction was reported in 5 articles and was significantly higher in AIS (68.4%) vs. AdIS (61.4%) (MD = -7.2, 95%CI = -11.6,-2.7,p = 0.001). EBL was not significantly different between AIS and AdIS (695.6 mL vs 817.7 mL,p = 0.204). Furthermore, no difference was found in operative time (MD = 37.9 min,95%CI = -10.7;86.6,p = 0.127), total instrumented level (MD = 0.88,95%CI = -0.7,2.4,p = 0.273), and LOS (MD = 0.5, 95%CI = -0.2;1.2, p = 0.188). Four articles reported postoperative complications in AIS vs AdIS, with no difference in neurological deficit, instrumentation-related complications, and medical complications. CONCLUSION AIS patients had better radiographic correction compared to AdIS. Though no difference was found in perioperative outcomes and complications, these findings emphasize the importance of counseling patients regarding the optimal timing of surgical correction.
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Affiliation(s)
- Jeffrey W Chen
- School of Medicine, Vanderbilt University, Nashville, TN, USA
| | - Hani Chanbour
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Rishabh Gupta
- School of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Justine Izah
- School of Medicine, Meharry Medical College, Nashville, TN, USA
| | | | - Amir M Abtahi
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21st Ave S, South Tower, Suite #4200, Nashville, TN, 37232, USA
| | - Scott L Zuckerman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21st Ave S, South Tower, Suite #4200, Nashville, TN, 37232, USA
| | - Byron F Stephens
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21st Ave S, South Tower, Suite #4200, Nashville, TN, 37232, USA.
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Gessara A, Patel MS, Estefan M, Koch JEJ, Gutman N, Mardashti A, Shetaiwi A, Quraishi NA. Restoration of the sagittal profile according to the Roussouly classification reduces mechanical complications and revision surgery in older patients undergoing surgery for adult spinal deformity (ASD). Eur Spine J 2024; 33:563-570. [PMID: 37768339 DOI: 10.1007/s00586-023-07885-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 07/14/2023] [Accepted: 08/04/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE The mechanical complications related to ASD remain a concern due to their morbidity and associated revision surgery. Restoration of each patient's Roussouly profile may reduce these. Our aim was to examine if the restoration of the Roussouly profile reduced these complications and revision rates in older patients operated for degenerative ASD. METHODS Retrospective analysis of a single-centre, 2-year minimum follow-up patient database. All patients undergoing corrective surgery (≥ 4 levels) for ASD were included with analysis of demographic data, operative records, restoration of Roussouly sagittal profile, mechanical complications and revision rates. Univariate and multivariate analysis was conducted. RESULTS Fifty-two patients were included (mean age was 72.3 years, average follow-up 56.3 months). Twenty-six patients had a "restored" profile (50%) and 26 an "unrestored" profile (50%). The incidence of mechanical complications was 7 (27%) and 23 (88%) for the restored and unrestored groups, respectively (p < 0.001). Revision rates were 4 (15.4%) and 18 (69.2%), respectively (p < 0.000), in the restored and unrestored profiles. Univariate analysis determined that profile restoration and BMI were associated with mechanical complications and revision surgery, whilst only the profile restoration status maintained its statistical power in multivariate analysis (p = 0.002 and p = 0.002, respectively). Age was not a significant factor in univariate analysis. The relative risk for mechanical failure and revision surgery was 5.6 times (CI 1.929-16.39) and 3.08 times (CI 1.642-5.734) greater if the profile was not restored. CONCLUSIONS Achieving each patient's ideal Roussouly profile is associated with a reduced incidence of mechanical complications and revision rates in the older population after surgery for degenerative ASD.
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Affiliation(s)
- Alan Gessara
- Queens Medical Centre, Centre for Spinal Studies and Surgery, Nottingham, UK.
| | | | - Martin Estefan
- Queens Medical Centre, Centre for Spinal Studies and Surgery, Nottingham, UK
| | - Jonathan E J Koch
- Queens Medical Centre, Centre for Spinal Studies and Surgery, Nottingham, UK
| | - Nadav Gutman
- Queens Medical Centre, Centre for Spinal Studies and Surgery, Nottingham, UK
| | - Ali Mardashti
- Queens Medical Centre, Centre for Spinal Studies and Surgery, Nottingham, UK
| | - Ali Shetaiwi
- Queens Medical Centre, Centre for Spinal Studies and Surgery, Nottingham, UK
| | - Nasir Ali Quraishi
- Queens Medical Centre, Centre for Spinal Studies and Surgery, Nottingham, UK
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Pressman E, Liaw D, Monsour M, Wang CP, Gassie K, Alikhani P. Factors associated with hardware failure after lateral thoracolumbar fusions - A ten year case series. Clin Neurol Neurosurg 2022; 224:107564. [PMID: 36587530 DOI: 10.1016/j.clineuro.2022.107564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 12/14/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Thoracolumbar lateral interbody fusions (tLLIF) are one tool in the spine surgeon's toolbox to indirectly decompress neuroforamina while also improving segmental lordosis in a biomechanically distinct manner from posterior fusions. When part of a concomitant posterior construct, hardware failure (HF), sometimes requiring revision surgery, can occur. We sought to study the relationship between tLLIF and HF. METHODS We conducted a retrospective study on consecutive patents who underwent tLLIF at a single academic center between January 2012 and December 2021 by seven unique neurosurgeons. Patients were excluded if they had no posterior instrumentation within their construct or if they had less than six months of follow-up. Hardware failure was defined as screw breakage or rod fracture seen on postoperative imaging. RESULTS 232 patients were identified; 6 (2.6 %) developed HF throughout a mean follow-up of 1182 days (range =748-1647 days). Adjacent segment disease was the most common pathology addressed (75 patients (32.3 %)). The amount of posterior instrumentation both in the surgery in question and in the total construct were significantly higher in the HF cohort (4.33 ± 1.52 levels, 5.83 ± 3.36 levels) versus the non-HF cohort (2.08 ± 0.296 levels, p = 0.014; 2.86 ± 0.316 levels, p = 0.003, respectively). The number of interbody devices added in the index surgery and in the entire construct were both significantly higher in the HF cohort (3.33 ± 0.666 interbody devices, 3.33 ± 0.666 devices) than in the non-HF cohort (1.88 ± 0.152 interbody devices, p = 0.002; 2.31 ± 0.158 devices, p = 0.036, respectively). Higher amounts of lateral levels of fusion approached significance for association with HF (HF: 2.67 ± 0.844 levels, no HF: 1.73 ± 1.26 levels, p = 0.076). On multivariate analysis, only the number of interbody devices added in the index surgery was predictive of HF (Odds ratio=2.3, 95 % confidence interval=1.25-4.23, p = 0.007). CONCLUSION Greater levels of posterior fusion, and greater numbers of interbody devices in an index surgery and in a construct as a whole, were associated with higher rates of HF in our cohort of patients with tLLIF. Greater numbers of lateral segments fused in this population may also be related to HF.
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Affiliation(s)
- Elliot Pressman
- Department of Neurosurgery & Brain Repair, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Deborah Liaw
- Department of Neurosurgery & Brain Repair, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Molly Monsour
- Department of Neurosurgery & Brain Repair, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Christopher P Wang
- Department of Neurosurgery & Brain Repair, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Kelly Gassie
- Department of Neurosurgery & Brain Repair, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Puya Alikhani
- Department of Neurosurgery & Brain Repair, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
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Zarchi O, Ohana N, Mercado E, Amitai A, Berestizshevsky Y, Sheinis D, Benharroch D, Bar-On E. A practical method for real-time detection of pedicle wall breaching during funneling. Arch Orthop Trauma Surg 2022; 142:3017-3025. [PMID: 33877449 DOI: 10.1007/s00402-021-03885-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 03/27/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND A reliable, real-time method for the detection of pedicle wall breaching during funnelling in spine deformity surgery could be accessible to any surgeon assisted with neuromonitoring. METHODS Fifty-six consecutive patients (1066 pedicles), who were submitted to spinal deformity surgery from December 2013 to July 2015 were included in the study group. A control group of 13 consecutive patients (226 pedicles) with spinal deformity surgery were operated on from January to December 2013 and were excluded from finder stimulation. In the study cohort, continuous stimulation during funnelling was delivered via a finder and subsequently a compound muscle action potential (CMAP) threshold was determined. Following funnelling, manual inspection of the pedicular internal walls was performed. The CMAP thresholds were compared with the results of palpation to determine the sensitivity and specificity of the technique for detecting pedicular breaching. To cover common ranges of damage, the medial and lateral breaches were compared and the concave-apical breaches compared to the non-apical or convex-apical breaches. In addition, a pedicle screw test was estimated for all patients. RESULTS ROC analysis showed 9 mA cut-off to have a sensitivity of 88.0% and a specificity of 89.5% for predicting pedicular breaching, with an area under the curve of 0.92 (95% confidence interval 0.90-0.94; P < 0.001). Using 9 mA threshold as an alert criterion, funnelling at the concave-apical pedicles showed significantly more true and false positive alerts and fewer true negative alerts when compared with the non-apical and convex-apical pedicles (P < 0.001). Medial breaches had significantly lower stimulation thresholds than lateral breaches (P < 0.001). Thresholds of screw-testing were significantly higher for study than for control-patients (P = 0.002). CONCLUSIONS Finder stimulation has a considerably higher sensitivity and specificity for prediction of pedicular breaching, most prominent for medial breaches. Screw-testing displayed significantly better results in patients undergoing the finder stimulation technique, as compared with the control group. The main advantages of our method are its high safety level and low cost, which may be critical in less affluent countries. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Omer Zarchi
- Intraoperative Neurophysiology Unit, Rabin Medical Center, Beilinson Hospital, 39 Jabotinski St, 49100, Petach Tikva, Israel.
| | - Nissim Ohana
- Orthopaedics, Meir Medical Center, Kfar-Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Mercado
- Pediatric Orthopedic Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Amir Amitai
- Spine Surgery Unit, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | | | - Dimitri Sheinis
- Orthopaedics, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Daniel Benharroch
- Pathology Department, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Elhanan Bar-On
- Israel Center for Disaster Medicine and Humanitarian Response, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
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Girod PP, Kögl N, Molliqaj G, Lener S, Hartmann S, Thomé C. Flexing a standard hinge-powered operating table for lumbosacral three-column osteotomy (3-CO) site closure in 84 consecutive patients. Neurosurg Rev 2021; 45:517-524. [PMID: 33963469 DOI: 10.1007/s10143-021-01559-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/22/2021] [Accepted: 05/03/2021] [Indexed: 11/25/2022]
Abstract
Three-column osteotomy (3-CO) is a powerful technique in adult deformity surgery, and pedicle subtraction osteotomy (PSO) is the workhorse to correct severe kyphotic spinal deformities. Aging of the population, increasing cases of iatrogenic flat back deformities and understanding the importance of sagittal balance have led to a dramatic increase of this surgical technique. Surgery, however, is demanding and associated with high complication rates so that every step of the procedure requires meticulous technique. Particularly, osteotomy closure is associated with risks like secondary fracture, translation, or iatrogenic stenosis. This step is traditionally performed by compression or a cantilever maneuver with sometimes excessive forces on the screws or instrumentation. Implant loosening or abrupt subluxation resulting in construct failure and/or neurological deficits can result. The aim of this prospective registry study was to assess the efficacy and safety of our surgical PSO technique as well as the osteotomy closure by flexing a hinge-powered OR table. In a series of 84 consecutive lumbosacral 3-CO, a standardized surgical technique with special focus on closure of the osteotomy was prospectively evaluated. The surgical steps with the patients positioned prone on a soft frame are detailed. Osteotomy closure was achieved by remote controlled bending of a standard OR table without compressive or cantilever forces in all 84 cases. This technique carries a number of advantages, particularly the reversibility and the slow speed of closure with minimum force. There was not a single mechanical intraoperative complication such as vertebral body fracture, subluxation, or adjacent implant loosening during osteotomy closure, compared to external cohorts using the cantilever technique (p = 0.130). The feasibility of controlled 3-CO closure by flexing a standard OR table is demonstrated. This technique enables a safe, gentle closure of the osteotomy site with minimal risk of implant failure or accidental neurological injury.
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Affiliation(s)
- Pierre-Pascal Girod
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, MZA 3rd floor, Tyrol, 6020, Austria.
| | - Nikolaus Kögl
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, MZA 3rd floor, Tyrol, 6020, Austria
| | - Granit Molliqaj
- Department of Neurosurgery, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Sara Lener
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, MZA 3rd floor, Tyrol, 6020, Austria
| | - Sebastian Hartmann
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, MZA 3rd floor, Tyrol, 6020, Austria
| | - Claudius Thomé
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, MZA 3rd floor, Tyrol, 6020, Austria
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Adeyemo EA, Aoun SG, Barrie U, Nguyen ML, Badejo O, Pernik MN, Christian Z, Dosselman LJ, El Ahmadieh TY, Hall K, Reyes VP, McDonagh DL, Bagley CA. Enhanced Recovery After Surgery Reduces Postoperative Opioid Use and 90-Day Readmission Rates After Open Thoracolumbar Fusion for Adult Degenerative Deformity. Neurosurgery 2021; 88:295-300. [PMID: 32893863 DOI: 10.1093/neuros/nyaa399] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 07/02/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The role of enhanced recovery after surgery (ERAS) pathways implementation has not been previously explored in adult deformity patients. OBJECTIVE To determine the impact of ERAS pathways implementation in adult patients undergoing open thoraco-lumbar-pelvic fusion for degenerative scoliosis on postoperative outcome, opioid consumption, and unplanned readmission rates. METHODS In this retrospective single-center study, we included 124 consecutive patients who underwent open thoraco-lumbar-pelvic fusion from October 2016 to February 2019 for degenerative scoliosis. Primary outcomes consisted of postoperative supplementary opioid consumption in morphine equivalent dose (MED), postoperative complications, and readmission rates within the postoperative 90-d window. RESULTS There were 67 patients in the ERAS group, and 57 patients served as pre-ERAS controls. Average patient age was 69 yr. The groups had comparable demographic and intraoperative variables. ERAS patients had a significantly lower rate of postoperative supplemental opioid consumption (248.05 vs 314.05 MED, P = .04), a lower rate of urinary retention requiring catheterization (5.97% vs 19.3%, P = .024) and of severe constipation (1.49% vs 31.57%, P < .0001), and fewer readmissions after their surgery (2.98% vs 28.07%, P = .0001). CONCLUSION A comprehensive multidisciplinary approach to complex spine surgery can reduce opioid intake, postoperative urinary retention and severe constipation, and unplanned 90-d readmissions in the elderly adult population.
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Affiliation(s)
- Emmanuel A Adeyemo
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Salah G Aoun
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Umaru Barrie
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Madelina L Nguyen
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Olatunde Badejo
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Mark N Pernik
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Zachary Christian
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Luke J Dosselman
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Tarek Y El Ahmadieh
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Kristen Hall
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Valery Peinado Reyes
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - David L McDonagh
- Department of Anesthesiology and Pain Management, UT Southwestern Medical Center, Dallas, Texas
| | - Carlos A Bagley
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, Texas.,Department of Orthopedic Surgery, UT Southwestern Medical Center, Dallas, Texas
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Schupper AJ, Neifert SN, Martini ML, Gal JS, Yuk FJ, Caridi JM. Surgeon experience influences patient characteristics and outcomes in spine deformity surgery. Spine Deform 2021; 9:341-348. [PMID: 33105015 DOI: 10.1007/s43390-020-00227-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 10/10/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE To characterize differences in patient demographics and outcomes by surgeon experience in a cohort of patients undergoing adult spinal deformity surgery. METHODS Patients undergoing degenerative spinal deformity were included. Patients whose surgeons graduated from fellowship ≤ 5 years prior to surgery versus > 5 years were compared. Multivariable linear and logistic regression, controlling for age, sex, comorbidity burden, number of segments fused, blood loss and operative time were used to evaluate differences in outcomes. Characteristics of operative invasiveness were plotted against surgeons' level of experience, and trends in these measures were assessed with univariate linear regression. RESULTS Three-hundred sixty-three patients were included. 147 patients' surgeons had ≤ 5 years of experience. Patient demographics were evenly matched. Patients with junior surgeons had more pre-existing medical complications, and senior surgeons were less likely to take care of patients with Medicare/Medicaid (p < 0.001). Junior surgeons were more likely to operate on non-elective patients (p < 0.001). Patients of junior surgeons received larger fusions (9.6 vs. 7.6 segments fused, p < 0.001). There were no differences in complication rates or death. Patients of junior surgeons had longer overall length of stays (p = 0.037) and higher rates of nonhome discharge (OR 2.0, p < 0.001), 30- and 90-day (p < 0.005) ED visits, and higher costs (+ $8548, 95% CI: $1596 to $15,502; p = 0.016). CONCLUSION Junior surgeons tend to perform more extensive deformity operations on more medically complex patients compared to senior surgeons, associated with higher costs and more resource utilization than senior surgeons.
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Affiliation(s)
- Alexander J Schupper
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
| | - Sean N Neifert
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Michael L Martini
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Jonathan S Gal
- Department of Anesthesiology, Perioperative, and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Frank J Yuk
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - John M Caridi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
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Bari TJ, Hansen LV, Gehrchen M. Surgical correction of Adult Spinal Deformity in accordance to the Roussouly classification: effect on postoperative mechanical complications. Spine Deform 2020; 8:1027-37. [PMID: 32279244 DOI: 10.1007/s43390-020-00112-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 03/25/2020] [Indexed: 12/13/2022]
Abstract
STUDY DESIGN Single-center, retrospective. OBJECTIVES To assess the restoration of ideal sagittal spine shape in accordance to the Roussouly classification and the effect on postoperative mechanical complications. Surgical correction of Adult Spinal Deformity is both challenging and complex. The risk of postoperative complications is considerable, especially mechanical complications requiring revision surgery. Attention has been directed toward defining alignment targets in attempts to minimize these risks, and the Roussouly classification has been proposed as a potential surgical aim. METHODS All patients undergoing ASD surgery from 2013-2016 were included at a single, quaternary institute. Successful restoration of Roussouly spine shape was retrospectively assessed, and patients were classified as either "restored" or "non-restored". Cumulative incidence of revision surgery due to mechanical failure was estimated using the Aalen-Johansen estimator, with death as the competing risk. A multivariable proportional odds model was used to estimate the effect of the Roussouly algorithm on revision surgery due to mechanical failure. RESULTS We identified a complete and consecutive cohort of 233 patients who were followed for a mean period of 36 (± 14) months. The 2-year cumulative incidence of revision surgery was 28%. Comparing the "restored" to the "non-restored" group, the overall revision rates were high in both groups. However, when adjusting for known cofounders in a multivariable proportional odds analysis, there was an almost fivefold increased odds of revision due to mechanical failure in the "non-restored" group (p = 0.036). CONCLUSION Surgical correction of ASD in accordance to the ideal Roussouly spine shape was correlated to a marked and significant decrease in risk of revision surgery due to mechanical failure. Nonetheless, the overall revision risk was elevated in both groups. LEVEL OF EVIDENCE Therapeutic III.
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Jacobs E, van Royen BJ, van Kuijk SMJ, Merk JMR, Stadhouder A, van Rhijn LW, Willems PC. Prediction of mechanical complications in adult spinal deformity surgery-the GAP score versus the Schwab classification. Spine J 2019; 19:781-788. [PMID: 30503298 DOI: 10.1016/j.spinee.2018.11.013] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 11/27/2018] [Accepted: 11/28/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Surgery for adult spinal deformity is a challenging and complex procedure with high reported complication (8.4%-42%) and revision rates (9%-17.6%). Failure to achieve or maintain adequate postoperative sagittal alignment has been reported to be the main cause of mechanical complications. In order to define appropriate surgical targets, the Scoliosis Research Society-Schwab classification and the Global Alignment and Proportion (GAP) score were established. In the literature, no study has yet compared these classification systems with respect to the risk of developing mechanical complications. PURPOSE To assess and compare the ability of the Schwab classification and the GAP score to predict mechanical complications following adult spinal deformity surgery. STUDY DESIGN Two-center, retrospective cohort study. PATIENT SAMPLE Thirty-nine patients suffering adult spinal deformity who underwent long segment spinal fusion (≥4 levels), minimum follow-up of 2years. OUTCOME MEASURES The ability of the Schwab classification and GAP score to predict mechanical failure was determined by computing the Area Under the receiver operating characteristic curve. METHODS Full-spine pre- and postoperative radiographs of all patients were analyzed for mechanical complications. Subsequently, the pre- and postoperative Schwab and GAP score were determined. Logistic regression analysis was used to assess the ability of both systems to determine which was the most appropriate for the prediction of mechanical failure. Correlations between the various factors constituting the GAP score and Schwab classification were estimated using the Spearman rank order correlation coefficient. RESULTS The results demonstrated that both classification systems are capable of predicting radiographic evidence of mechanical failure; however, the GAP score proved to be significantly better (p=.003). The relative pelvic version of the GAP score serves a similar role as the pelvic tilt modifier from the Schwab classification (ρ=-0.84, p<.01). The relative lumbar lordosis from the GAP score functions much like the PI-LL modifier from the Schwab classification (ρ=-0.94, p<.01). The GAP score is most significantly dependent on relative spinopelvic alignment, relative lumbar lordosis, and relative pelvic version (ρ=0.85, ρ=0.84, and ρ=0.84, respectively, p<.01). Correlation with the lordosis distribution index was also significant but was not as strong (ρ=0.65, p<.01). Age, on the contrary, showed poor correlation with the GAP score (ρ=0.17, p=.300). CONCLUSIONS Both the Schwab classification and the GAP score are capable of predicting mechanical complications. The GAP score proved to be significantly more appropriate. This difference is probably attributed to the fact that in the GAP score all parameters are related to the patient's individual pelvic incidence.
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Affiliation(s)
- Eva Jacobs
- Department of Orthopedic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Barend J van Royen
- Department of Orthopedic Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Johannes M R Merk
- Department of Finance, Maastricht University, Maastricht, the Netherlands
| | - Agnita Stadhouder
- Department of Orthopedic Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Lodewijk W van Rhijn
- Department of Orthopedic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Paul C Willems
- Department of Orthopedic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands.
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Piantoni L, Noel MA, Francheri Wilson IA, Tello CA, Galaretto E, Remondino RG, Bersusky ES. Surgical Treatment With Pedicle Screws of Scoliosis Associated With Osteogenesis Imperfecta in Children. Spine Deform 2017; 5:360-365. [PMID: 28882354 DOI: 10.1016/j.jspd.2017.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 03/06/2017] [Accepted: 03/10/2017] [Indexed: 10/18/2022]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE To assess results of posterior instrumented fusion using pedicle screws in 12 children with osteogenesis imperfecta (OI) with spinal deformity at a single institution from 2001 to 2012. SUMMARY OF BACKGROUND DATA This is the first case series of OI patients who underwent non-cement augmented screw-rod instrumented fusion published in the literature. METHODS Of a total of 54 children with spinal deformity associated with OI, 12 (22.2%) were submitted to posterior spinal fusion with pedicle screws (80% density) because of severe spinal deformity. Here we reported the results in seven females and five males. RESULTS Five thoracic (41.7%), five double (thoracic and lumbar 41.7%), and two lumbar (16.7%) curves were considered. The mean number of fused levels was 11.8 (range: 5 to 16). Mean age at surgery was 13 years 8 months. Mean follow-up was 7 years 11 months (range: 3 years 7 months to 16 years 1 month). The mean preoperative scoliosis angle was 75.6°, whereas the postoperative angle was 31.4° (58.5% correction rate). The mean preoperative kyphosis angle was 57.4° and the postoperative angle was 42.3°. We observed one superficial infection, one dural tear, and three cases of proximal junctional kyphosis; two patients required one revision surgery each (2 years and 4 months postoperatively on average). CONCLUSIONS To our knowledge, this is the first case series published in the literature regarding OI with instrumented fusion with non-cement augmented pedicle screws exclusively in children with spinal deformity. We found that posterior spinal fusion with the screw-rod system in OI deformity in children is feasible and reliable, and has acceptable clinical and imaging results in the long-term follow-up. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Lucas Piantoni
- Spine Surgery Service, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, CABA, Buenos Aires, Argentina.
| | - Mariano A Noel
- Spine Surgery Service, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, CABA, Buenos Aires, Argentina
| | - Ida A Francheri Wilson
- Spine Surgery Service, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, CABA, Buenos Aires, Argentina
| | - Carlos A Tello
- Spine Surgery Service, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, CABA, Buenos Aires, Argentina
| | - Eduardo Galaretto
- Spine Surgery Service, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, CABA, Buenos Aires, Argentina
| | - Rodrigo G Remondino
- Spine Surgery Service, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, CABA, Buenos Aires, Argentina
| | - Ernesto S Bersusky
- Spine Surgery Service, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, CABA, Buenos Aires, Argentina
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