Cause and Effect of Revisions in Adult Spinal Deformity Surgery: A Multicenter Study on Outcomes Based on Etiology.

dc.contributor.author

Passias, Peter G

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Dave, Pooja

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Smith, Justin S

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Lafage, Renaud

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Onafowokan, Oluwatobi O

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Tretiakov, Peter

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Mir, Jamshaid

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Line, Breton

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Diebo, Bassel

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Daniels, Alan H

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Gum, Jeffrey L

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Eastlack, Robert

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Hamilton, D Kojo

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Chou, Dean

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Klineberg, Eric O

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Kebaish, Khaled M

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Lewis, Stephen

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Gupta, Munish C

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Kim, Han Jo

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Lenke, Lawrence G

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Ames, Christopher P

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Shaffrey, Christopher I

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Schwab, Frank J

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Lafage, Virginie

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Bess, Shay

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Hostin, Robert

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Burton, Douglas C

dc.date.accessioned

2025-02-03T15:13:25Z

dc.date.available

2025-02-03T15:13:25Z

dc.date.issued

2024-12

dc.description.abstract

Background context

While the treatment of adult spinal deformity (ASD) has increasingly favored surgical correction, the incidence of revision surgery remains high. Yet, little has been explored on the association between the etiology of reoperation and patient outcomes.

Purpose

To assess the impact of the etiology of revision surgery on postoperative outcomes.

Study design/setting

Retrospective cohort analysis.

Patient sample

891 ASD patients.

Outcome measures

Complications, radiographic parameters, disability metrics.

Methods

Operative ASD patients with at least 1 revision stratified by etiology (mechanical [Mech] -pseudoarthrosis, thoracic decompensation without junctional failure, x-ray malalignment, implant failure, implant malposition, PJK ± major malalignment; infection [Infx]-early vs late onset, major vs minor; wound [Wound]; SI pain [SI Pain]). Excluded multiple etiologies, and intraoperative or medical complications. Data from the immediate visit prior to the final revision was used as baseline (rBL). Follow-up based on visits best aligned to time points after final revision. Radiographic parameters SVA, PI-LL, and PT were used to assess alignment post-revision via ANOVA. Multivariate analysis controlling for relevant covariates assessed outcome differences after final revision surgery.

Results

891 MET INCLUSION (AGE: 60.40±14.17, 77% F, BMI: 27.97±5.87 KG/M2, CCI: : 1.80±1.73). Etiology groups were as follows: Mech: 432; Infx: 296; Wound: 65; SI Pain: 98. Surgically, Infx had lower rates of osteotomy, interbody fusion, and decompression (p<.05). Infx and SI Pain demonstrated similar correction in radiographics SVA, PI-LL, and PT (p>.05), whereas Mech had significantly less improvement by 2 years (p<.003) that improved by 5 years. Compared to without revision, the odds of MCID in ODI were 48.6% lower across groups (OR: 0.514 [.280, .945], p=.032). Indications of x-ray malalignment were 93.0% less likely to reach MCID (OR: 0.071, [.006, .866], p=.038). Similarly, implant failure negatively impacted rates of MCID (40% vs. 15.2%, p=.029). Those with PJK had 57% lower odds of MCID (33% vs 54%, OR: .43, [0.2, 0.9] p= 0.023), further negated by major malalignment (OR: 0.05, [.07, .97], p=.02). Indications of pseudarthrosis, thoracic decompensation, implant malposition were not significant. Major sepsis had lower rates of MCID compared to minor (6.4% vs. 21.2%), and early onset infection improved compared to late (OR: 1.43, [1.17, 2.98], p<.001). In the early follow-up period, the Mech group has significantly worse SRS Pain and Mental Health scores compared to other groups (1-year: Mech 1.56 vs Infx 0.83 vs SI Pain 0.72, p<0.001; 2-year: 1.88 vs 0.71 vs 0.76, p=0.034). Complication rates increased with the number of revisions and with mechanical indication (all p<.05). At 5 years, patient satisfaction was significantly more likely to improve compared to early follow-up (OR: 1.22, p=.011), along with improved pain score, in Mech group (0.89 vs 0.49 vs 0.56, p=.081).

Conclusions

This study focused on the impact of revision as it varies with etiology and time of occurrence postoperatively. Compared to other etiologies, revision surgery due to mechanical complications had less radiographic improvement and worsening patient-reported scores in the early postoperative period despite stabilization at 5 years. The depth of impact of mechanical complication, particularly with the addition of malalignment, merits greater focus during surgical planning.

Level of evidence

III.
dc.identifier

S1529-9430(24)01226-9

dc.identifier.issn

1529-9430

dc.identifier.issn

1878-1632

dc.identifier.uri

https://hdl.handle.net/10161/32043

dc.language

eng

dc.publisher

Elsevier BV

dc.relation.ispartof

The spine journal : official journal of the North American Spine Society

dc.relation.isversionof

10.1016/j.spinee.2024.12.023

dc.rights.uri

https://creativecommons.org/licenses/by-nc/4.0

dc.subject

Adult spine deformity

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Complications

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Etiology

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Realignment

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Reoperation

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Revision

dc.title

Cause and Effect of Revisions in Adult Spinal Deformity Surgery: A Multicenter Study on Outcomes Based on Etiology.

dc.type

Journal article

duke.contributor.orcid

Passias, Peter G|0000-0002-1479-4070|0000-0003-2635-2226

duke.contributor.orcid

Shaffrey, Christopher I|0000-0001-9760-8386

pubs.begin-page

S1529-9430(24)01226-9

pubs.organisational-group

Duke

pubs.organisational-group

School of Medicine

pubs.organisational-group

Clinical Science Departments

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Orthopaedic Surgery

pubs.organisational-group

Neurosurgery

pubs.publication-status

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