Browsing by Author "Lenke, LG"
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Item Open Access Evolution and Advancement of Adult Spinal Deformity Research and Clinical Care: An Overview of the Scoli-RISK-1 Study(Global Spine Journal, 2019-05-01) Cerpa, M; Lenke, LG; Fehlings, MG; Shaffrey, CI; Cheung, KMC; Carreon, LYStudy Design: Narrative review. Objective: The prevalence of adult spinal deformity (ASD) has been cited anywhere between 2-32%, while the prevalence in the elderly population has been estimated at 68%. Neurologic complications following ASD surgery remains a concern. Previous literature reported incidence of neurologic complications varied between 1-10%, while non-neurologic complications reported were as high as 50%. To assess the incidence of neurologic deficits, complications, and outcomes following ASD surgery, an international group of spine deformity surgeons initiated a prospective, multicenter, international, observational study: Scoli-RISK-1. Methods: Two hundred seventy-two patients were enrolled from 15 centers with ASD having primary or revision surgery with a major Cobb≥80°, revision including an osteotomy, and/or a complex 3-column osteotomy. Patients had lower extremity muscle strength (LEMS) exams performed preoperatively and at specific time points through 2-year follow-up. Results: Preoperatively, 203 patients (74.9%) had no LEMS impairment (normal) and 68 (25.1%) had a LEMS of <50 (abnormal). Compared with baseline, 23.0% of all patients experienced a LEMS decline at discharge, with this rate decreasing to 17.1% at 6-weeks and to 9.9% at 6-months and remaining stable at 10.0% at 2-years. Conclusion: This study revealed that a decline in LEMS after complex ASD surgery is common and more frequent than previously reported. We identified such a decline in 23.0% of patients at discharge, with neurologic function recovering over time to a decline of 10.0% at 2-years postoperatively. The Scoli-RISK-1 study revealed valuable information regarding the incidence, natural history, and prognosis of neurologic and non-neurologic complications following ASD surgery and provides useful information for patient counseling.Item Open Access Evolving concepts in pelvic fixation in adult spinal deformity surgery(Seminars in Spine Surgery, 2023-01-01) Turner, JD; Schupper, AJ; Mummaneni, PV; Uribe, JS; Eastlack, RK; Mundis, GM; Passias, PG; DiDomenico, JD; Harrison Farber, S; Soliman, MAR; Shaffrey, CI; Klineberg, EO; Daniels, AH; Buell, TJ; Burton, DC; Gum, JL; Lenke, LG; Bess, S; Mullin, JPLong-segment adult spinal deformity (ASD) constructs carry a high risk of mechanical complications. Pelvic fixation was introduced to improve distal construct mechanics and has since become the standard for long constructs spanning the lumbosacral junction. Pelvic fixation strategies have evolved substantially over the years. Numerous techniques now use a variety of entry points, screw trajectories, and construct configurations. We review the various strategies for pelvic fixation in ASD in a systematic review of the literature and update the techniques employed in the International Spine Study Group Complex Adult Deformity Surgery database.Item Open Access Intraoperative neuromonitoring has a poor correlation with postoperative neurological deficits in noncord level adult deformity surgery(Spine Journal, 2024-09-01) Sardar, Z; Swamy, G; Yoshida, G; Kelly, MP; Strantzas, S; Basu, S; Kwan, K; Smith, JS; Pellise, F; Gupta, MC; Jones, KE; Charalampidis, A; Rocos, B; Lewis, SJ; Lenke, LGBACKGROUND CONTEXT: Intraoperative neuromonitoring (IONM) is routinely used during spinal deformity surgery. While it is highly effective at detecting spinal cord level changes, the utility for surgery at a noncord level is less known. The purpose of this study is to evaluate rates of new neural deficits relative to IONM alerts in noncord-level spinal deformity surgery. PURPOSE: In noncord-level spinal deformity surgery, postop neural deficits are incompletely associated with IONM alerts. The purpose of this study was to assess the efficacy of neuromonitoring in detecting and preventing neurological deficits. STUDY DESIGN/SETTING: Prospective, international, multicenter cohort. PATIENT SAMPLE: A total of 197 adult patients undergoing spinal deformity surgery at a noncord level. OUTCOME MEASURES: IONM changes defined as loss of amplitude>50% in SSEP or MEP from baseline or sustained EMG activity lasting>10 seconds were recorded. Postoperative new neurological deficits were recorded. Other outcomes measured were baseline demographics, radiographic alignment parameters, events leading to and following IONM alerts. METHODS: Twenty international centers prospectively documented IONM (EMG, SSEP and MEP), demographics, radiographic findings, and surgical events of patients (10-80 years) undergoing spinal deformity surgery. Inclusion criteria: neurologically intact, spinal deformity correction with major Cobb>80° or involving any osteotomy. IONM change was defined as loss of amplitude>50% in SSEP or MEP from baseline or sustained EMG activity lasting>10 seconds. RESULTS: Of 197 patients, 22 (11.2%) had an IONM alert. More patients were undergoing revision surgery during an alert compared to those with no alert (40.9% vs 18.9%, p = 0.026). IONM alerts did not correlate with coronal cobb angle, deformity angular ratio, sagittal vertical axis, or coronal vertical axis. There were a total of 26 alerts in 22 patients - 4 patients (18.2%) had 2 IONM alerts, while the other 18 (81.8%) had 1 alert. MEPs were affected in 21 of 26 alerts (80.8%) and 15 (71.4%) of those were recovered. Isolated MEP changes were seen in 16 of 26 alerts (61.5%). SSEPs were affected in 8 of 26 alerts (30.8%). Isolated SSEP changes were seen in 3 (11.5%). Lastly, EMGs were affected in only 2 (7.7%) and were isolated. Five of 21 MEP alerts (23.8%) were bilateral, whereas 16 (76.2%) were unilateral. The most frequent event preceding an MEP change was an osteotomy in 6 (28.6%) of 21 patients. The most frequent nonsurgical event preceding an MEP alert was technical in 5 (23.8%), followed by systemic (low blood pressure/anemia) and anesthetic in 3 patients each (14.3%). Thirty-three of 197 patients (16.8%) developed a new postop neural deficit. Of these patients, 24 (72.7%) had no IONM alert. In the presence of an IONM alert 9 of 22 (40.9%) had a new neural deficit. IONM alert and development of new neural deficit had a crude negative predictive value (NPV) of 86.1%. CONCLUSIONS: In noncord-level spinal deformity surgery, IONM alerts occurred in 11.2% of patients, with osteotomy being the most frequent preceding surgical event. A new postop neural deficit was observed in 16.8% of all patients, and in 41% of patients with a IONM alert. A surprisingly high 73% of postop neural deficits occurred in patients who did not have an alert. This highlights the need for further refinement of IONM techniques and alert criteria for noncord-level surgery. FDA Device/Drug Status: This abstract does not discuss or include any applicable devices or drugs.Item Open Access Rapid response during spinal deformity surgery can successfully save spinal cord function using intraoperative monitoring.(Spine Journal, 2024-09-01) Theologis, AA; Gupta, MC; Swamy, G; Yoshida, G; Kelly, MP; Strantzas, S; Basu, S; Kwan, K; Smith, JS; Pellise, F; Kato, S; Sardar, Z; Ames, CP; Jones, KE; Charalampidis, A; Rocos, B; Lenke, LG; Lewis, SJThis abstract contains content that is significantly similar to the authors' previously published abstract in the Global Spine Journal Rapid Fire. For access to the original publication, please visit the following DOI: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11086046/pdf/10.1177_21925682241239518.pdf.Item Open Access Redefining Clinically Significant Blood Loss in Complex Adult Spine Deformity Surgery(Spine, 2024-01-01) Daher, M; Xu, A; Singh, M; Lafage, R; Line, BG; Lenke, LG; Ames, CP; Burton, DC; Lewis, SM; Eastlack, RK; Gupta, MC; Mundis, GM; Gum, JL; Hamilton, KD; Hostin, R; Lafage, V; Passias, PG; Protopsaltis, TS; Kebaish, KM; Schwab, FJ; Shaffrey, CI; Smith, JS; Bess, S; Klineberg, EO; Diebo, BG; Daniels, AHStudy Design. Retrospective analysis of prospectively-collected data Objective. This study aims to define clinically relevant blood loss in adult spinal deformity (ASD) surgery. Background. Current definitions of excessive blood loss following spine surgery are highly variable and may be suboptimal in predicting adverse events (AE). Methods. Adults undergoing complex ASD surgery were included. Estimated blood loss (EBL) was extracted for investigation, and estimated blood volume loss (EBVL) was calculated by dividing EBL by the preoperative blood volume utilizing Nadler's formula. LASSO regression was performed to identify five variables from demographic and peri-operative parameters. Logistic regression was subsequently performed to generate a receiver operating characteristics (ROC) curve and estimate an optimal threshold for EBL and EBVL. Finally, the proportion of patients with AE plotted against EBL and EBVL to confirm the identified thresholds. Results. In total 552 patients were included with a mean age of 60.7±15.1 years, 68% females, mean CCI was 1.0±1.6, and 22% experienced AEs. LASSO regression identified ASA score, baseline hypertension, preoperative albumin, and use of intra-operative crystalloids as the top predictors of an AE, in addition to EBL/EBVL. Logistic regression resulted in ROC curve which was used to identify a cut-off of 2.3 liters of EBL and 42% for EBVL. Patients exceeding these thresholds had AE rates of 36% (odds-ratio: 2.1, 95% CI [1.2-3.6]) and 31% (odds-ratio: 1.7, 95% CI [1.1-2.8]), compared to 21% for those below the thresholds of EBL and EBVL, respectively. Conclusion. In complex ASD surgery, intraoperative EBL of 2.3 liters and an EBVL of 42% are associated with clinically-significant AEs. These thresholds may be useful in guiding preoperative-patient-counseling, healthcare system quality initiatives, and clinical perioperative bloodloss management strategies in patients undergoing complex spine surgery. Additionally, similar methodology could be performed in other specialties to establish procedure-specific clinically-relevant bloodloss thresholds.Item Open Access Responding to Intraoperative Neuromonitoring Changes During Pediatric Coronal Spinal Deformity Surgery(Global Spine Journal, 2019-05-01) Lewis, SJ; Wong, IHY; Strantzas, S; Holmes, LM; Vreugdenhil, I; Bensky, H; Nielsen, CJ; Zeller, R; Lebel, DE; de Kleuver, M; Germscheid, N; Alanay, A; Berven, S; Cheung, KMC; Ito, M; Polly, DW; Shaffrey, CI; Qiu, Y; Lenke, LGStudy Design: Retrospective case study on prospectively collected data. Objectives: The purpose of this explorative study was: 1) to determine if patterns of spinal cord injury could be detected through intra-operative neuromonitoring (IONM) changes in pediatric patients undergoing spinal deformity corrections, 2) to identify if perfusion based or direct trauma causes of IONM changes could be distinguished, 3) to observe the effects of the interventions performed in response to these events, and 4) to attempt to identify different treatment algorithms for the different causes of IONM alerts. Methods: Prospectively collected neuromonitoring data in pre-established forms on consecutive pediatric patients undergoing coronal spinal deformity surgery at a single center was reviewed. Real-time data was collected on IONM alerts with >50% loss in signal. Patients with alerts were divided into 2 groups: unilateral changes (direct cord trauma), and bilateral MEP changes (cord perfusion deficits). Results: A total of 97 pediatric patients involving 71 females and 26 males with a mean age of 14.9 (11-18) years were included in this study. There were 39 alerts in 27 patients (27.8% overall incidence). All bilateral changes responded to a combination of transfusion, increasing blood pressure, and rod removal. Unilateral changes as a result of direct trauma, mainly during laminotomies for osteotomies, improved with removal of the causative agent. Following corrective actions in response to the alerts, all cases were completed as planned. Signal returned to near baseline in 20/27 patients at closure, with no new neurological deficits in this series. Conclusion: A high incidence of alerts occurred in this series of cases. Dividing IONM changes into perfusion-based vs direct trauma directed treatment to the offending cause, allowing for safe corrections of the deformities. Patients did not need to recover IONM signal to baseline to have a normal neurological examination.Item Open Access Severe hip and knee osteoarthritis worsens patient-reported disability in adult spinal deformity patients(Spine Journal, 2024-09-01) Balmaceno-Criss, M; Singh, M; Xu, A; Daher, M; Lafage, R; Lewis, SJ; Klineberg, EO; Eastlack, RK; Gupta, MC; Mundis, GM; Gum, JL; Hamilton, DK; Hostin, RA; Passias, PG; Protopsaltis, TS; Kebaish, KM; Kim, HJ; Shaffrey, CI; Smith, JS; Line, B; Lenke, LG; Ames, CP; Burton, DC; Bess, S; Schwab, FJ; Lafage, V; Diebo, BG; Daniels, AHBACKGROUND CONTEXT: The complex interplay between lower extremity osteoarthritis and sagittal alignment in adult spinal deformity patients is of growing clinical interest. PURPOSE: To quantify the sequential effects of lower extremity OA on PROMs in ASD patients. STUDY DESIGN/SETTING: Retrospective review of prospectively collected data. PATIENT SAMPLE: ASD patients with no prior history of thoracolumbar surgery, and available baseline PROMs and standing radiographs were included. OUTCOME MEASURES: Baseline demographics, spinopelvic alignment, and PROMs. METHODS: Included patients with PROMs, standing xrays, no prior thoracolumbar surgery, and bilateral Kellgren-Lawrence (KL) hip/knee grade at baseline. Patients grouped into Spine (KL <3 BL hips & knees), Spine-Hip (KL>3 BL hips, KL <3 BL knees), Spine-Knee (KL>3 BL knees, KL>3 BL hips), Spine-Hip-Knee (KL>3 BL hips & knees). Baseline demographics, spinopelvic alignment, and PROMs were compared. Multivariate regression with forward stepwise selection predicted PROMs with variables (demographic, radiographic, OA severity) with significant association identified on Pearson correlation RESULTS: Included 160 patients: 56 Spine, 32 Spine-Knee, 20 Spine-Hip, and 52 Spine-Hip-Knee. Spine-Hip-Knee patients were older (Spine=62.2, Spine-Knee=61.2, Spine-Hip=59.1, Spine-Hip-Knee=68.5; p<.001) but similar in sex, comorbidities, and frailty; p>.05. Spine-Hip-Knee patients had higher SVA (50.0,30.6,60.5,83.5), T1PA (25.2,20.4,20.3,27.8), GSA (3.7,2.3,4.3,7.5), and KA (0.0,2.1,2.9,10.5); p<.005. SRS total and VR12 PCS scores were similar but VR12-2b climbing stairs (1.73,1.91,1.55,1.40, p=.014) and SRS-8 back pain at rest (2.29,2.84,1.95,2.71, p=.012) were lower in Spine-Hip-Knee and Spine-Hip, respectively. ODI (42.75,35.88,50.30,44.59, p=.040) and ODI Pain (2.88,1.84,2.90,2.46, p=0.019) were higher in Spine-Hip patients; ODI lifting was higher in hip OA patients but not significant (2.95,2.69,3.45,3.35, p>.05). In multivariate analyses, KOA changed the prediction of ODI pain from R2 0.052 to 0.086 and SRS-8 from R2 0.077 to 0.147. HOA changed the prediction of VR12-2b from R2 0.113 to 0.140 and ODI Lifting from R2 0.175 to 0.202. Frailty impacted PROMs across all models (p<.001) and GSA changed ODI, ODI pain, and VR12-2b models (p<.05). CONCLUSIONS: Severe hip and knee OA worsen patient-reported disability and physical function in ASD patients. These results quantify the impact of lower limb arthritis on patient reported outcomes, and highlight the need for integrated assessment and management of both spinal alignment and joint health in patients. FDA Device/Drug Status: This abstract does not discuss or include any applicable devices or drugs.Item Open Access Three-dimensional evaluation of the dynamic interplay between pelvic anatomy, lower-limb compensation, and standing alignment in ASD(Spine Journal, 2024-09-01) Assi, A; Khalifé, M; Prince, G; Boutros, M; Karam, M; Ames, CP; Bess, S; Daniels, AH; Gupta, MC; Hostin, RA; Kelly, MP; Kim, HJ; Klineberg, EO; Lenke, LG; Nunley, PD; Passias, PG; Schwab, FJ; Shaffrey, CI; Smith, JS; Lafage, R; Diebo, BG; Lafage, VBACKGROUND CONTEXT: Previous studies have shown that lower limbs play a crucial role in compensating for sagittal spinal malalignment. However, these studies primarily focused on lower limb parameters in the sagittal plane, mainly knee flexion, leaving compensatory mechanisms that might happen in the coronal or axial planes unexplored. PURPOSE: This study aimed to investigate factors associated with lower-limb recruitment in adult spinal deformity (ASD) patients. STUDY DESIGN/SETTING: Retrospective study of prospectively collected data. PATIENT SAMPLE: ASD patients who underwent full-body biplanar X-rays and 3D reconstruction of lower limbs and pelvis. OUTCOME MEASURES: Association between morphological parameters and compensatory mechanisms METHODS: The study included ASD patients with moderate to severe sagittal plane deformities. Classic 2D parameters included pelvic shift (PSh), knee flexion (KA), sacro-femoral (SFA), and ankle dorsiflexion (AA) angles for the lower limbs, as well as TPA, PT, PI, and PI-LL mismatch. 3D reconstructions were used to assess acetabular parameters (abduction, coverage, and anteversion), pelvic depth (PD: distance between the pubic symphysis and the sacral endplate), and knee varus/valgus angle. After univariate analysis, multiple linear regressions were performed to investigate associations between spinal deformity and lower limb 2D/3D parameters with and without accounting for spinal alignment. RESULTS: A total of 146 subjects (67±10 years) were included with a mean PI-LL of 25.1±16.1°, TPA 37.4±10.6°, PT 27±9.1°, and PD of 85.9±16.2mm. Lower limbs compensation consisted of a PSh 38.4±43.7mm, KA 6.9±7.9°, and AA of 5.8±4.1°. Pelvic depth significantly correlated with PI (r=0.6, p<0.001), PT (r=0.3, p<0.001), and SFA (r=0.2, p=0.02). In multivariate analysis considering the full-body parameters, ankle dorsiflexion (AA) was associated with PT, PSh, and KA (all p<0.001) but not with spinal alignment and correlated with increased knee varus angulation (p=0.01). Similarly, KA correlated with PT, SFA, and AA (all p<0.001) but not with spinal alignment. Those associations remained significant in multivariate analysis considering only the lower-limbs parameters. In addition, patients with high pelvic depth (>100mm) had greater pelvic shift and PT than low ones (<70mm): 29.4+49.1mm versus 54.8±41.7mm and 23.7±9.3° versus 32.4±9.4°. Finally, increased PT was associated with higher PI (p<0.001) and more vertical acetabular abduction (57.4±3.9° for PT<15°, vs 60.7±4.2° for PT > 25°, p=0.009). CONCLUSIONS: There was 3D analysis of the lower extremities that revealed significant multiplanar interplay in the setting of spinal deformity. Pelvic morphology including antero-posterior depth is associated with greater compensatory abilities such as pelvic translation and retroversion. Greater PT compensation in the sagittal plane is associated with a more vertical acetabulum in the coronal plane. Knee and ankle flexion were indirectly correlated with spinal alignment as they contributed to higher PT and pelvic shift. Consequently, their assessment is valuable for understanding how patients compensate for malalignment but should not be a primary consideration in the correction strategy. The sagittal and coronal alignment of lower limbs cannot be separated, as an increase in ankle and knee flexion angles is associated with greater genu varum. FDA Device/Drug Status: This abstract does not discuss or include any applicable devices or drugs.Item Open Access Use of supplemental rod constructs in adult spinal deformity surgery(Seminars in Spine Surgery, 2023-01-01) Buell, TJ; Sardi, JP; Yen, CP; Okonkwo, DO; Kojo Hamilton, D; Gum, JL; Lenke, LG; Shaffrey, CI; Gupta, MC; Smith, JSOperative treatment for adult spinal deformity (ASD) commonly involves long posterior instrumented fusions with primary rods spanning from the base of the construct to the upper instrumented vertebra. Over the past decade, additional supplemental rods have been increasingly utilized to bolster the primary instrumentation and mitigate risk of primary rod fracture/pseudarthrosis at areas of high biomechanical stress (e.g., 3-column osteotomy [3CO], multiple posterior column osteotomies [PCOs], lumbosacral junction). Supplemental rods for 3CO include satellite rods (4-rod technique with 2 deeply recessed short rods independently attached to pedicle screws across the 3CO), accessory rods (attached to primary rods via side-to-side connectors), and delta rods (accessory rods contoured only at the proximal and distal attachments to primary rods). Utilizing more than 4 rods across a 3CO may increase posterior construct stability; however, diminished load transfer to the anterior vertebral column may increase risk of nonunion and instrumentation failure. Similar supplemental rod constructs can be utilized to support multiple PCOs and/or the lumbosacral junction. We generally recommend using bilateral accessory rods for a total of 4 rods to support the lumbosacral junction (2 accessory rods and 2 primary rods). The novel “kickstand rod” can help facilitate coronal correction and/or function as an accessory rod distally anchored to an independent iliac screw; appropriate nomenclature is “iliac accessory rod” in cases without true kickstand distraction. In this narrative review, we aim to (1) provide a brief historical overview of supplemental rod constructs, (2) describe current indications for supplemental rods, and (3) report our results from a longitudinal analysis (2008–2020) of supplemental rod constructs used by International Spine Study Group (ISSG) surgeons.Item Open Access Who are super-utilizers in adult spine deformity surgery and how can surgeons identify them preoperatively?(Spine Journal, 2024-09-01) Nayak, P; Hostin, RA; Staub, BN; Gum, JL; Line, B; Bess, S; Lenke, LG; Lafage, R; Smith, JS; Mullin, JP; Kelly, MP; Diebo, BG; Buell, TJ; Scheer, JK; Lafage, V; Klineberg, EO; Kim, HJ; Passias, PG; Kebaish, KM; Eastlack, RK; Daniels, AH; Soroceanu, A; Mundis, GM; Protopsaltis, TS; Hamilton, DK; Gupta, MC; Schwab, FJ; Shaffrey, CI; Ames, CP; Burton, DCBACKGROUND CONTEXT: A relatively small percentage of patients are responsible for a disproportional amount of resource utilization in adult ASD surgery and contribute to significantly elevating the average cost across the surgically treated patients. These patients are called super-utilizers (SU). Modest reduction in the frequency of these super-utilization episodes has the potential to significantly improve the value of ASD surgery. PURPOSE: The goal of this study was to determine which, if any, baseline patient, radiographic, and/or surgical factors are the most important drivers of this disproportional increased resource utilization. We hypothesize that baseline patient factors predicts super-utilizers (SU) in adult spinal deformity surgery (ASD) more than surgical or deformity factors. STUDY DESIGN/SETTING: Retrospective Review of a prospective, multicenter registry. PATIENT SAMPLE: A total of 1299 index operative ASD patients eligible for 2-yr follow-up. OUTCOME MEASURES: Predictors of SU vs Non-SU in ASD. METHODS: A prospective multicenter consecutive series of ASD patients was reviewed. Inclusion criteria was diagnosis of ASD (scoliosis≥20°, C7-SVA≥5cm, PT≥25°, or TK≥60°), >4 level posterior fusion, and minimum 2-year follow-up. Index and total episode of care (EOC) cost in 2022 dollars were calculated using average itemized direct costs obtained from the administrative hospital records for all events in the inpatient EOC. Patients with total 2-year EOC cost greater than 90th percentile were considered SU. Multivariate generalized linear models were used to identify the most significant predictors of SU. RESULTS: A total of 1299 patients were eligible for 2-yr follow-up with mean age 60.0+14.1 years, 76% female, and 93% caucasians. SU patients are marginally older (+2.6 yrs; p=0.03), depressed (34.2% vs 25.8%; p=0.03) and tend to have higher propensity for fraility (p=0.003), comorbidities (0.01), reoperation rates (54.8% vs 17.0%; p<0.001), and LOS (+3 days; p<0.0001) compared to non-SU. While degree of sagittal deformity (Schwab sagittal modifiers, all p>0.05) and proportion of 3-column osteotomies (p>0.05) were similar between the groups, SU patients have higher surgical invasiveness score (+28; p<0.001), more vertebrae fused (+3; p<0.0001); more interbody fusions (80% vs 55%; p<0.0001), more BMP use (87.3% vs 69.4%; p=0.0002); longer OR time (+91 mins; p<0.0001), increased blood loss (+700 mL; p<0.0001), and longer length of stay (+3 days; p<0.0001). Index and EOC cost were 49% (p<0.0001) and 62% (p<0.0001) higher respectively in SU. While cost/QALY was 3-times higher in SU compared to non-SU. Multivariate analysis identified Schwab modifier SVA, surgical invasiveness, OR time, blood loss, BMP use, and LOS as strong predictors of SU (all p<0.01). CONCLUSIONS: Surgical invasiveness score greater than 118, being in OR for more than 7.6 hrs, blood loss more than 700 ml, utilizing BMP, and LOS more than 11 days were strong predictors of being a SU. Patients with SVA grade of + and ++ were less likely to be a SU compared to SVA grade 0. Procedural and resource utilization factors were strong predictors of being a SU compared to patient factors. FDA Device/Drug Status: This abstract does not discuss or include any applicable devices or drugs.Item Open Access Wound Closure and Wound Dressings in Adult Spinal Deformity Surgery From the AO Spine Surveillance of Post-Operative Management(Global Spine Journal, 2024-01-01) Oe, S; Swamy, G; Gagliardi, M; Lewis, SJ; Kato, S; Shaffrey, CI; Lenke, LG; Matsuyama, YStudy Design: An e-mail-based online survey for adult spinal deformity (ASD) surgeons. Objective: Wound closure and dressing techniques may vary according to the discretion of the surgeon as well as geographical location. However, there are no reports on most common methods. The purpose of this study is to clarify the consensus. Methods: An online survey was distributed via email to AO Spine members. Responses from 164 ASD surgeons were surveyed. The regions were divided into 5 regions: Europe and South Africa (ESA), North America (NA), Asia Pacific (AP), Latin America (LA), and Middle East and North Africa (MENA). Wound closure methods were evaluated by glue(G), staples(S), external non-absorbable sutures (ENS), tapes(T), and only subcuticular absorbable suture (SAS). Wound Dressings consisted of dry dressing (D), plastic occlusive dressing (PO), G, Dermabond Prineo (DP). Results: The number of respondents were 57 in ESA, 33 in NA, 36 in AP, 22 in LA, and 16 in MENA. S (36.4%) was the most used wound closure method. This was followed by ENS (26.2%), SAS (14.4%), G (11.8%), and T (11.3%). S use was highest in ESA (44.3%), NA (28.6%), AP (31.7%), and MENA (58.8%). D was used by 50% of surgeons postoperatively. AP were most likely to use PO (36%). 21% of NA used DP, while between 0%-9% of surgeons used it in the rest of the world. Conclusion: Wound closure and dressings methods differ in the region. There are no current guidelines with these choices. Future studies should seek to standardize these choices.