Browsing by Author "Reid, Daniel BC"
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Item Open Access Assessment of Patient Outcomes and Proximal Junctional Failure Rate of Adult Spinal Deformity Patients Undergoing Caudal Extension of Previous Spinal Fusion.(World neurosurgery, 2020-04-16) Daniels, Alan H; Reid, Daniel BC; Durand, Wesley M; Line, Breton; Passias, Peter; Kim, Han Jo; Protopsaltis, Themistocles; LaFage, Virginie; Smith, Justin S; Shaffrey, Christopher; Gupta, Munish; Klineberg, Eric; Schwab, Frank; Burton, Doug; Bess, Shay; Ames, Christopher; Hart, Robert A; International Spine Study GroupOBJECT:This case series examined patients undergoing caudal extension of prior fusion without alteration of the prior UIV to assess patient outcomes and rates of PJK/PJF. METHODS:Patients eligible for 2-year minimum follow-up undergoing caudal extension of prior fusion with unchanged UIVs were identified. These patients were evaluated for PJK/PJF, and patient reported outcomes were recorded. RESULTS:In total, 40 patients were included. Mean follow-up duration was 2.2 years (SD 0.3). Patients in this cohort had poor preoperative sagittal alignment (PI-LL 26.7°, TPA 29.0°, SVA 93.4mm) and achieved substantial sagittal correction (ΔSVA -62.2mm, ΔPI-LL -19.8°, ΔTPA -11.1°) following caudal extension surgery. At final follow-up, there was a 0% rate of PJF among patients undergoing caudal extension of previous fusion without creation of a new UIV, but 27.5% of patients experienced PJK. Patients experienced significant improvement in both ODI and SRS-22r total score at 2-years post-operatively (p<0.05). In total, 7.5% (n=3) of patients underwent further revision, at an average of 1.1 years (SD 0.54) after the surgery with unaltered UIV. All three of these patients underwent revision for rod fracture with no revisions for PJK/PJF. CONCLUSIONS:Patients undergoing caudal extension of previous fusions for sagittal alignment correction have high rates of clinical success, low revision surgery rates, and very low rates of PJF. Minimizing repetitive tissue trauma at the UIV may result in decreased PJF risk, as the PJF rate in this cohort of unaltered UIV patients is below historical PJF rates of patients undergoing sagittal balance correction.Item Open Access Evolution in Surgical Approach, Complications, and Outcomes in an Adult Spinal Deformity Surgery Multicenter Study Group Patient Population.(Spine deformity, 2019-05) Daniels, Alan H; Reid, Daniel BC; Tran, Stacie Nguyen; Hart, Robert A; Klineberg, Eric O; Bess, Shay; Burton, Douglas; Smith, Justin S; Shaffrey, Christopher; Gupta, Munish; Ames, Christopher P; Hamilton, D Kojo; LaFage, Virginie; Schwab, Frank; Eastlack, Robert; Akbarnia, Behrooz; Kim, Han Jo; Kelly, Michael; Passias, Peter G; Protopsaltis, Themistocles; Mundis, Gregory M; International Spine Study GroupStudy design
Retrospective review of a prospectively collected multicenter database.Objectives
To evaluate the evolution of surgical treatment strategies, complications, and patient-reported outcomes for adult spinal deformity (ASD) patients.Summary of background data
ASD surgery is associated with high complication rates. Evolving treatment strategies may reduce these risks.Methods
Adult patients undergoing ASD surgery from 2009 to 2016 were analyzed (n = 905). Preoperative and surgical parameters were compared across years. Subgroup analysis of 436 patients with minimum two-year follow-up was also performed.Results
From 2009 to 2016, there was a significant increase in the mean preoperative age (52 to 63.1, p < .001), body mass index (26.3 to 32.2, p = .003), Charlson Comorbidity index (1.4 to 2.2, p < .001), rate of previous spine surgery (39.8% to 53.1%, p = .01), and baseline disability (visual analog scale [VAS] back and leg pain) scores (p < .01), Oswestry Disability Index, and 22-item Scoliosis Research Society Questionnaire scores (p < .001). Preoperative Schwab sagittal alignment modifiers and overall surgical invasiveness index were similar across time. Three-column osteotomy utilization decreased from 36% in 2011 to 16.7% in 2016. Lateral lumbar interbody fusion increased from 6.4% to 24.1% (p = .004), anterior lumbar interbody fusion decreased from 22.9% to 16.7% (p = .043), and transforaminal lumbar interbody fusion/posterior lumbar interbody fusion utilization remained similar (p = .448). Use of recombinant human bone morphogenetic protein-2 (rhBMP-2) in 2012 was 84.6%, declined to 58% in 2013, and rebounded to 76.3% in 2016 (p = .006). Tranexamic acid use increased rapidly from 2009 to 2016 (13.3% to 48.6%, p < .001). Two-year follow-up sagittal vertical axis, pelvic tilt, pelvic incidence-lumbar lordosis, and maximum Cobb angles were similar across years. Intraoperative complications decreased from 33% in 2010 to 9.3% in 2016 (p < .001). Perioperative (<30 days, <90 days) complications peaked in 2010 (42.7%, 46%) and decreased by 2016 (24.1%, p < .001; 29.6%, p = .007). The overall complication rate decreased from 73.2% in 2008-2014 patients to 62.6% in 2015-2016 patients (p = .03). Two-year health-related quality of life outcomes did not significantly differ across the years (p > .05).Conclusions
From 2009 to 2016, despite an increasingly elderly, medically compromised, and obese patient population, complication rates decreased. Evolving strategies may result in improved treatment of ASD patients.Level of evidence
Level IV.Item Open Access Frailty and Health-Related Quality of Life Improvement Following Adult Spinal Deformity Surgery.(World neurosurgery, 2018-04) Reid, Daniel BC; Daniels, Alan H; Ailon, Tamir; Miller, Emily; Sciubba, Daniel M; Smith, Justin S; Shaffrey, Christopher I; Schwab, Frank; Burton, Douglas; Hart, Robert A; Hostin, Richard; Line, Breton; Bess, Shay; Ames, Christopher P; International Spine Study GroupAlthough the Adult Spinal Deformity Frailty Index (ASD-FI) predicts major complications and prolonged hospital length of stay after adult spinal deformity surgery, the impact of frailty on postoperative changes in health-related quality of life (HRQoL) is unknown.Patients who underwent instrumented fusion of ≥4 levels for adult spinal deformity with minimum 2-year follow-up were stratified by Adult Spinal Deformity Frailty Index score into 3 groups: nonfrail, frail, and severely frail. Baseline and follow-up demographics, HRQoL measures, and radiographic parameters were analyzed. Primary outcome measures included proportion of patients who achieved substantial clinical benefit (SCB) in terms of Oswestry Disability Index, 36-Item Short Form Health Survey Physical Component Summary, and numeric back and leg pain scores.Inclusion criteria were met by 332 patients (135 nonfrail, 175 frail, 22 severely frail). Frail and severely frail patients were older and had more comorbidities, worse baseline HRQoL and pain scores, and worse radiographic deformity than nonfrail patients (P < 0.05). At 2-year follow-up, all outcome scores were worse in frail and severely frail patients compared with nonfrail patients. Frail patients improved more than nonfrail patients and were more likely to reach SCB for Oswestry Disability Index (43.7% vs. 29.3%; P = 0.025), 36-Item Short Form Health Survey Physical Component Summary (56.9% vs. 51.2%; P = 0.03), and leg pain (45.8% vs. 23.0%; P = 0.03) scores, but not back pain (57.5% vs. 63.4%; P = 0.045) score.Despite higher risk stratification and worse baseline HRQoL, frail patients were more likely to reach SCB for most HRQoL measures compared with nonfrail patients. Severely frail patients were the least likely to reach SCB for most HRQoL measures.Item Open Access Peak Timing for Complications After Adult Spinal Deformity Surgery.(World neurosurgery, 2018-07) Daniels, Alan H; Bess, Shay; Line, Breton; Eltorai, Adam EM; Reid, Daniel BC; Lafage, Virginie; Akbarnia, Behrooz A; Ames, Christopher P; Boachie-Adjei, Oheneba; Burton, Douglas C; Deviren, Vedat; Kim, Han Jo; Hart, Robert A; Kebaish, Khaled M; Klineberg, Eric O; Gupta, Munish; Mundis, Gregory M; Hostin, Richard A; O'Brien, Michael; Schwab, Frank J; Shaffrey, Christopher I; Smith, Justin S; International Spine Study Group FoundationOverall complication rates for adult spinal deformity (ASD) surgery have been reported; however, little data exist on the peak timing associated with specific complications. This study quantifies the peak timing for multiple complication types in an ASD cohort at minimum 2-year follow-up.Multicenter, prospective analysis of all complications after ASD surgery in a consecutively enrolled cohort was performed. Inclusion criteria were ASD, age ≥18 years, spinal fusion ≥4 levels, and minimum 2-year follow-up. Complications included major and minor and specific complication types. Peak timing of specific complications was identified and described. Regression analysis was performed to assess correlation between patient/surgical factors and complication timing.There were 280 patients who met the inclusion criteria. Mean follow-up time was 2.9 years (range, 2-5 years). Of the patients, 209 (74.6%) had at least 1 complication, accounting for 529 total complications (258 minor and 271 major). Both major and minor complications peaked at <3 months. Infection and neurologic complications peaked at <3 months. Proximal junctional kyphosis had bimodal peaks at <3 and >24 months. Implant failure peaked at 12-24 and >24 months. There was a significant positive correlation between preoperative sagittal vertical axis and total complications at 6-12 months, major complications at 24 months, and reoperation. Body mass index was associated with total complications and implant failure at 12-24 and >24 months.The peak timing of specific complications after ASD surgery is identifiable. Understanding when these complications are likely to occur may improve patient counseling, early diagnosis, and prophylactic interventions and may help inform future reimbursement models.Item Open Access Rod Fracture After Apparently Solid Radiographic Fusion in Adult Spinal Deformity Patients.(World neurosurgery, 2018-09) Daniels, Alan H; DePasse, J Mason; Durand, Wesley; Hamilton, D Kojo; Passias, Peter; Kim, Han Jo; Protopsaltis, Themistocles; Reid, Daniel BC; LaFage, Virginie; Smith, Justin S; Shaffrey, Christopher; Gupta, Munish; Klineberg, Eric; Schwab, Frank; Burton, Doug; Bess, Shay; Ames, Christopher; Hart, Robert A; International Spine Study GroupRod fracture occurs with delayed fusion or pseudarthrosis after adult spinal deformity (ASD) surgery. Rod fracture after apparent radiographic fusion has not been previously investigated.Patients with ASD in a multicenter database were assessed for radiographic fusion by a committee of 3 spinal deformity surgeons. Fusions were rated as bilaterally fused (A), unilaterally fused (B), partially fused (C), or not fused (D). Patients with grade A or B fusion and 2-year follow-up were included. Patients with radiographic fusion were evaluated for subsequent rod fracture. Adjusted analyses were conducted with multiple logistic regression, using backwards-variable selection to a threshold of P < 0.2, to assess for associated factors.Of 402 patients with radiographically apparent solid fusion, 9.5% (38) subsequently suffered a broken rod. On multivariate analysis, greater rates of rod fracture were seen among patients of age group 60-69 years (vs. 18-49), body mass index 30-34 and 35+ (vs. <25), stainless-steel rods (vs. titanium), patients with rods ≤5.5 mm (vs. 6.35 mm), and patients with Charlson score 0 (vs. 3+). Of the 38 patients with rod fractures, 18 (47.4%) presented with worsened pain, and 8 (21.1%) required revision at minimum 2-year follow-up.Rod fracture occurred in 9.5% of patients with apparently solid radiographic fusion after ASD surgery. Advanced age, obesity, small diameter rods (5.5 mm), osteotomy, and lower comorbidity burden were significantly associated with rod fracture. Nearly one-half of these patients noted worsening pain, and 21.1% required revision surgery. Instrumentation failure may occur and may be symptomatic even in the setting of apparent fusion on plain radiographs.Item Open Access Upper-thoracic versus lower-thoracic upper instrumented vertebra in adult spinal deformity patients undergoing fusion to the pelvis: surgical decision-making and patient outcomes.(Journal of neurosurgery. Spine, 2019-12-20) Daniels, Alan H; Reid, Daniel BC; Durand, Wesley M; Hamilton, D Kojo; Passias, Peter G; Kim, Han Jo; Protopsaltis, Themistocles S; Lafage, Virginie; Smith, Justin S; Shaffrey, Christopher I; Gupta, Munish; Klineberg, Eric; Schwab, Frank; Burton, Douglas; Bess, Shay; Ames, Christopher P; Hart, Robert A; International Spine Study GroupOBJECTIVE:Optimal patient selection for upper-thoracic (UT) versus lower-thoracic (LT) fusion during adult spinal deformity (ASD) correction is challenging. Radiographic and clinical outcomes following UT versus LT fusion remain incompletely understood. The purposes of this study were: 1) to evaluate demographic, radiographic, and surgical characteristics associated with choice of UT versus LT fusion endpoint; and 2) to evaluate differences in radiographic, clinical, and health-related quality of life (HRQOL) outcomes following UT versus LT fusion for ASD. METHODS:Retrospective review of a prospectively collected multicenter ASD database was performed. Patients with ASD who underwent fusion from the sacrum/ilium to the LT (T9-L1) or UT (T1-6) spine were compared for demographic, radiographic, and surgical characteristics. Outcomes including proximal junctional kyphosis (PJK), reoperation, rod fracture, pseudarthrosis, overall complications, 2-year change in alignment parameters, and 2-year HRQOL metrics (Lumbar Stiffness Disability Index, Scoliosis Research Society-22r questionnaire, Oswestry Disability Index) were compared after controlling for confounding factors via multivariate analysis. RESULTS:Three hundred three patients (169 LT, 134 UT) were evaluated. Independent predictors of UT fusion included greater thoracic kyphosis (odds ratio [OR] 0.97 per degree, p = 0.0098), greater coronal Cobb angle (OR 1.06 per degree, p < 0.0001), and performance of a 3-column osteotomy (3-CO; OR 2.39, p = 0.0351). While associated with longer operative times (ratio 1.13, p < 0.0001) and greater estimated blood loss (ratio 1.31, p = 0.0018), UT fusions resulted in greater sagittal vertical axis improvement (-59.5 vs -41.0 mm, p = 0.0035) and lower PJK rates (OR 0.49, p = 0.0457). No significant differences in postoperative HRQOL measures, reoperation, or overall complication rates were detected between groups (all p > 0.1). CONCLUSIONS:Greater deformity and need for 3-CO increased the likelihood of UT fusion. Despite longer operative times and greater blood loss, UT fusions resulted in better sagittal correction and lower 2-year PJK rates following surgery for ASD. While continued surveillance is necessary, this information may inform patient counseling and surgical decision-making.