Browsing by Author "Buckland, Aaron J"

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    Incidence of perioperative medical complications and mortality among elderly patients undergoing surgery for spinal deformity: analysis of 3519 patients.
    (Journal of neurosurgery. Spine, 2017-11) Jain, Amit; Hassanzadeh, Hamid; Puvanesarajah, Varun; Klineberg, Eric O; Sciubba, Daniel M; Kelly, Michael P; Hamilton, D Kojo; Lafage, Virginie; Buckland, Aaron J; Passias, Peter G; Protopsaltis, Themistocles S; Lafage, Renaud; Smith, Justin S; Shaffrey, Christopher I; Kebaish, Khaled M; International Spine Study Group
    OBJECTIVE Using 2 complication-reporting methods, the authors investigated the incidence of major medical complications and mortality in elderly patients after surgery for adult spinal deformity (ASD) during a 2-year follow-up period. METHODS The authors queried a multicenter, prospective, surgeon-maintained database (SMD) to identify patients 65 years or older who underwent surgical correction of ASD from 2008 through 2014 and had a minimum 2 years of follow-up (n = 153). They also queried a Centers for Medicare & Medicaid Services claims database (MCD) for patients 65 years or older who underwent fusion of 8 or more vertebral levels from 2005 through 2012 (n = 3366). They calculated cumulative rates of the following complications during the first 6 weeks after surgery: cerebrovascular accident, congestive heart failure, deep venous thrombosis, myocardial infarction, pneumonia, and pulmonary embolism. Significance was set at p < 0.05. RESULTS During the perioperative period, rates of major medical complications were 5.9% for pneumonia, 4.1% for deep venous thrombosis, 3.2% for pulmonary embolism, 2.1% for cerebrovascular accident, 1.8% for myocardial infarction, and 1.0% for congestive heart failure. Mortality rates were 0.9% at 6 weeks and 1.8% at 2 years. When comparing the SMD with the MCD, there were no significant differences in the perioperative rates of major medical complications except pneumonia. Furthermore, there were no significant intergroup differences in the mortality rates at 6 weeks or 2 years. The SMD provided greater detail with respect to deformity characteristics and surgical variables than the MCD. CONCLUSIONS The incidence of most major medical complications in the elderly after surgery for ASD was similar between the SMD and the MCD and ranged from 1% for congestive heart failure to 5.9% for pneumonia. These complications data can be valuable for preoperative patient counseling and informed consent.
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    Should Sagittal Spinal Alignment Targets for Adult Spinal Deformity Correction Depend on Pelvic Incidence and Age?
    (Spine, 2020-02) Protopsaltis, Themistocles S; Soroceanu, Alexandra; Tishelman, Jared C; Buckland, Aaron J; Mundis, Gregory M; Smith, Justin S; Daniels, Alan; Lenke, Lawrence G; Kim, Han Jo; Klineberg, Eric O; Ames, Christopher P; Hart, Robert A; Bess, Shay; Shaffrey, Christopher I; Schwab, Frank J; Lafage, Virginie; International Spine Study Group (ISSG)

    Study design

    Retrospective analysis.

    Objective

    Determine whether deformity corrections should vary by pelvic incidence (PI).

    Summary of background data

    Alignment targets for deformity correction have been reported for various radiographic parameters. The T1 pelvic-angle (TPA) has gained in applications for adult spinal deformity (ASD) surgical-planning since it directly measures spinal alignment separate from pelvic- and lower-extremity compensation. Recent studies have demonstrated that ASD corrections should be age specific.

    Methods

    A prospective database of consecutive ASD patients was analyzed in conjunction with a normative spine database. Clinical measures of disability included the Oswestry Disability Index (ODI) and Short Form 36 Survey (SF-36) Physical Component Score (PCS). Baseline relationships between TPA, age, PI, and ODI/SF-36 PCS scores were analyzed in the ASD and asymptomatic patients. Linear regression modeling was used to determine alignment targets based on PI and age-specific normative SF-36-PCS values.

    Results

    Nine hundred three ASD patients (mean 53.7 yr) and 111 normative subjects (mean 50.7 yr) were included. Patients were subanalyzed by PI: low, medium, high (<40, 40-75, >75); and age: elderly (>65 yr, n = 375), middle age (45-65 yr, n = 387), and young (18-45 yr, n = 141). TPA and SRS-Schwab parameters correlated with age and PI in ASD and normative subjects (r = 0.42, P < 0.0001). ODI correlated with PCS (r = 0.71, P < 0.0001). Linear regression analysis using age-normative SF-36-PCS values demonstrated that ideal spinopelvic alignment is less strict with increasing PI and age.

    Conclusion

    Targets for ASD correction should vary by age and PI. This is demonstrated in both asymptomatic and ASD subjects. Using age-normative SF-36 PCS values, alignment targets are described for different age and PI categories. High-PI patients do not require as rigorous realignments to attain age-specific normative levels of health status. As such, sagittal spinal alignment targets increase with increasing age as well as PI.

    Level of evidence

    3.