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Major complications in revision adult deformity surgery: risk factors and clinical outcomes with 2- to 7-year follow-up.

Abstract：

STUDY DESIGN:Retrospective cohort comparative study. OBJECTIVE:To determine the prevalence of major complications, identify risk factors, and assess long-term clinical benefit after revision adult spinal deformity surgery. SUMMARY OF BACKGROUND DATA:No study has analyzed risk factors for major complications in long revision fusion surgery and whether or not occurrence of a major complication affects ultimate clinical outcome. METHODS:Analysis of consecutive adult patients who underwent multilevel revision surgery for spinal deformity with a minimum 2-year follow-up was performed. All complications were classified as either major or minor. Outcome analysis was conducted with the Scoliosis Research Society and Oswestry Disability Index scores. RESULTS:A total of 166 patients (mean age = 53.8 years) were identified with a mean follow-up of 3.5 years (range: 2-7). Primary diagnoses included idiopathic/de novo scoliosis (107), degenerative (35), trauma (7), neuromuscular scoliosis (6), congenital deformity (5), ankylosing spondylitis (2), tumor (2), Scheuermann kyphosis (1), and rheumatoid arthritis (1). Most common secondary diagnoses that necessitated revision surgery were adjacent segment disease, fixed sagittal imbalance, and pseudarthrosis. Overall, 34.3% of patients developed major complications (19.3% perioperative; 18.7% follow-up). Associated risk factors for perioperative complications were patient- (age > 60 years, medical comorbidities, obesity) and surgery-related (pedicle subtraction osteotomy). Performance of a 3-column osteotomy and postoperative radiographic changes that suggested progressive loss of sagittal correction were recognized as risk factors for follow-up complications. Equivalent outcome scores were reported by patients preoperatively, but those experiencing follow-up complications reported lower scores at the final follow-up. CONCLUSION:Overall, 34.4% of patients experienced major complications after long revision fusion surgery. Different risk factors were identified for perioperative versus follow-up complications. The occurrence of a follow-up, not but perioperative, major complication seemed to have a negative impact on ultimate clinical outcome.

journal_name

Spine (Phila Pa 1976)

journal_title

Spine

authors

Cho SK,Bridwell KH,Lenke LG,Yi JS,Pahys JM,Zebala LP,Kang MM,Cho W,Baldus CR

doi

10.1097/BRS.0b013e3182217ab5

subject

Has Abstract

pub_date

2012-03-15 00:00:00

pages

489-500

issue

eissn

0362-2436

issn

1528-1159

journal_volume

pub_type

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Major complications in revision adult deformity surgery: risk factors and clinical outcomes with 2- to 7-year follow-up.