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Average 3.7 of 44 Ratings
What is the incidence of major complications following adult spinal deformity surgery?
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Studies have shown major complications occur in 10% of patients that undergo adult spinal deformity surgery.
Major complications are reported in approximately 10% of pateints undergoing adult spinal deformity surgery. Many of these major complications, such as neurologic deficits, cardiac events, and thromboembolic events are irreversible and adversely affect the long term health of the patient. Patients undergoing adult spinal deformity should have a thorough understanding of the risks prior to proceeding with surgery.
Glassman et al. looked at patients undergoing adult spinal deformity surgery and found forty-seven major complications were reported in 46 patients. Sixty-two minor complications were noted in 46 patients. They found major complications adversely affected the SF-12 general health scores at 1 year after surgery. The most common major complication found at follow up was instrumentation failure.
Piasecki et al. looked at the rate of thormboembolic disease (TED) in 66 consecutive adult patients who underwent extensive anterior/posterior spinal reconstructions for spinal deformity. They found the total incidence of postoperative TED was 13.6%. The overall rate of DVT was 9.1%, one-third occurring in the pelvis. PE developed in 7.6%. Right-sided thoracoabdominal approaches were associated with an increased risk of developing DVT, PE, and TED.
Sansur et al. queried the Scoliosis Research Society (SRS) morbidity and mortality database from 2004 to 2007. Complications were identified and analyzed on the basis of patient characteristic and surgical techniques. They found the overall complication rate for AS treatment is 13.4%, and that the complication rate is significantly higher when osteotomies, revision procedures, and combined anterior/posterior approaches are used. Complication rate was not influenced by scoliosis type or age.
Illustration A shows the frequency of intraoperative, perioperative, and follow-up complications from the Glassman et al. study.
Glassman SD, Hamill CL, Bridwell KH, Schwab FJ, Dimar JR, Lowe TG
Spine. 2007 Nov;32(24):2764-70. PMID: 18007258 (Link to Abstract)
Glassman, SPINE 2007
Piasecki DP, Poynton AR, Mintz DN, Roh JS, Peterson MG, Rawlins BA, Charles G, Boachie-Adjei O
Spine. 2008 Mar;33(6):668-72. PMID: 18344861 (Link to Abstract)
Piasecki, SPINE 2008
Sansur CA, Smith JS, Coe JD, Glassman SD, Berven SH, Polly DW Jr, Perra JH, Boachie-Adjei O, Shaffrey CI.
Spine (Phila Pa 1976). 2011 Apr 20;36(9):E593-7. PMID: 21325989 (Link to Abstract)
Sansur, SPINE 2011
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Average 1.0 of 58 Ratings
A 53-year-old woman is seen in the adult spine clinic for long-standing back pain. History reveals she had untreated scoliosis as a child. Her current radiographs are shown in Figures A and B. Due to discomfort with ADLs and progressive pain, surgical intervention is planned. Which of the following factors would increase her risk of nonunion?
An anterior thoracoabdominal approach
Preoperative Cobb angle of 60 degrees
Age greater than 35 years
A posterior midline approach
Positive sagittal balance < 5 cm
In the surgical treatment of adult idiopathic scoliosis, a thoracoabdominal approach has been shown to have higher rates of pseudoarthrosis compared to posterior procedures.
Raizman et al reviewed pseudoarthrosis in spinal patients. Multiple factors, including smoking, kyphosis >20 degrees, positive sagittal balance greater than 5cm, preexisting hip arthritis, age greater than 55, and a throacoabdominal approach were determined to be significant risk factors.
Kim et al retrospectively analyzed 144 patients who underwent spinal instrumentation and fusion to S1 at a minimum of a 2-year follow-up. Factors that significantly affected achieving a successful fusion were hip arthritis, age greater than 55 years, and incomplete sacropelvic fixation.
Figures A and B are standing scoliosis films in the coronal and sagittal plan showing a patient with adult idiopathic scoliosis.
Answer 2: A Cobb angle of 60 degrees has not been shown to correlate with pseudoarthrosis.
Answer 3: Age greater than 55 years is associated with an increased rate of pseudoarthrosis.
Answer 4: A posterior approach with fusion to the upper thoracic spine has not been shown to correlate with pseudoarthrosis.
Answer 5: Positive sagittal balance greater than 5 cm is associated with an increased rates of pseudoarthrosis.
Kim YJ, Bridwell KH, Lenke LG, Rhim S, Cheh G.
Spine (Phila Pa 1976). 2006 Sep 15;31(20):2329-36. PMID: 16985461 (Link to Abstract)
Kim, SPINE 2006
Raizman NM, O'Brien JR, Poehling-Monaghan KL, Yu WD.
J Am Acad Orthop Surg. 2009 Aug;17(8):494-503. PMID: 19652031 (Link to Abstract)
Raizman, JAAOS 2009
Average 2.0 of 47 Ratings
In patients with adult scoliosis requiring long thoracolumbar fusions, which of the following is the major advantage of extending the fusion to the sacrum as opposed to ending at L5.
Improved function outcomes
Decreased pseudoarthosis rates
Decreased major medical complications
Improved correction and maintenance of sagittal balance
Improved curve correction in the coronal plane
In adult patients with spinal deformity, extension of a long fusion to the sacrum is associated with improved correction and maintenance of sagittal balance.
Edwards et al did a retrospective cohort study looking at patients with fusion to L5 versus those fused to the sacrum. Patients fused to the sacrum showed improved correction and maintenance of their sagittal balance. However patients fused to the sacrum also had an increased rate of pseudoarthosis and major medical complications. There was no difference in functional outcomes or degree of coronal correction between the two groups.
The study by Kuhns et al is an extension of the Edwards study with longer term follow-up. They found that advanced degeneration at L5-S1 occurred in 69% of deformity patients after long fusions to L5 with 5 to 20 year follow-up. The development of advanced degeneration at L5-S1 was highly correlated with the development of positive sagittal balance.
Edwards CC, Bridwell KH, Patel A, Rinella AS, Berra A, Lenke LG
Spine. 2004 Sep;29(18):1996-2005. PMID: 15371700 (Link to Abstract)
Edwards, SPINE 2004
Kuhns CA, Bridwell KH, Lenke LG, Amor C, Lehman RA, Buchowski JM, Edwards C 2nd, Christine B.
Spine (Phila Pa 1976). 2007 Nov 15;32(24):2771-6. PMID: 18007259 (Link to Abstract)
Kuhns, SPINE 2007
Average 3.0 of 20 Ratings
In adult patients with scoliosis, severity of symptoms correlates with which of the following variables?
Magnitude of coronal Cobb angle
Number of spine levels involved in the deformity
Level of the apex of the curve
Sagittal balance is the most reliable radiographic predictor of clinical health status in adults with spinal deformity.
Glassman et al evaluated 752 patient of which a positive sagittal imbalance was identified in 352 patients. As the C7 plumb line deviation increased, poorer results were found in all measures of health status. In addition, patients in this study with lumbar kyphosis had more overall measured disability compared to controls.
Schwab et al as a method of classifying adult scoliosis, define criteria based on radiographic markers of disability which ultimately showed correlation with patient-reported disability and need for operative treatment.
Kim et al analyzed the causes, prevalence, and risk factors for sagittal thoracic decompensation in patients post lumbar spinal instrumentation and found that postoperative sagittal imbalance, smaller lumbar lordosis, preoperative sagittal imbalance and age at surgery > 55yrs were risk factors for thoracic decompensation.
Illustration A demonstrated how sagittal imbalance is measured.
Schwab F, Farcy JP, Bridwell K, Berven S, Glassman S, Harrast J, Horton W.
Spine (Phila Pa 1976). 2006 Aug 15;31(18):2109-14. PMID: 16915098 (Link to Abstract)
Schwab, SPINE 2006
Glassman SD, Bridwell K, Dimar JR, Horton W, Berven S, Schwab F.
Spine (Phila Pa 1976). 2005 Sep 15;30(18):2024-9. PMID: 16166889 (Link to Abstract)
Glassman, SPINE 2005
Kim YJ, Bridwell KH, Lenke LG, Rhim S, Cheh G.
Spine (Phila Pa 1976). 2006 Sep 15;31(20):2359-66. PMID: 16985465 (Link to Abstract)
Average 3.0 of 24 Ratings
Lateral Deformity Techniques was presented by Antoine Tohmeh, MD at the Seattle...
HPI - A 68 year old female who works as a house wife presents with a history of backache and lower back pain that started 3 months ago.
The pain started gradually with an insidious onset but progressed in nature. In the beginning, the pain was worse with long standing and walking with no radiculopathy. It was relieved with analgesic medications.
Later on, approximately 1 month ago, the pain became more severe, radiated to left leg and associated with paraesthesia at the level of L4,5 and present while lying in bed at night. The pain was associated with a feeling of weakness, weight loss, and poor appetite. The patient has not had a clear fever. Currently, the pain is not controlled with analgesic medications (including tramadol).
What is the diagnosis?