When Not to Operate in Spinal Deformity: Identifying Subsets of Patients with Simultaneous Clinical Deterioration, Major Complications, and Reoperation.

Abstract

Study design

Retrospective review of a prospectively enrolled adult spinal deformity (ASD) database.

Objective

To investigate what patient factors elevate the risk of sub-optimal outcomes after deformity correction.

Background

Currently, it is unknown what factors predict a poor outcome after adult spinal deformity surgery, which may require increased pre-operative consideration and counseling.

Methods

Patients >18yrs undergoing surgery for ASD(scoliosis≥20°, SVA≥5 cm, PT≥25°, or TK≥60°). An unsatisfactory outcome was defined by the following categories met at 2Y: (1) clinical: deteriorating in ODI at 2Y f/u (2) complications/reop: having a reoperation and major complication were deemed high risk for poor outcomes postoperatively (HR). Multivariate analyses assessed predictive factors of HR patients in adult spinal deformity patients.

Results

633 ASD (59.9 years, 79%F, 27.7 kg/m2, CCI: 1.74) were included. Baseline severe Schwab modifier incidence (++): 39.2% PI-LL, 28.8% SVA, 28.9% PT. 15.5% of patients deteriorated in ODI by 2 years, while 7.6% underwent a reoperation and had a major complication. This categorized 11 (1.7%) as HR. HR were more comorbid in terms of arthritis (73%) heart disease (36%) and kidney disease (18%), P<0.001. Surgically, HR had greater EBL (4431ccs), underwent more osteotomies (91%), specifically Ponte(36%) and Three Column Osteotomies(55%), which occurred more at L2(91%). HR underwent more PLIFs (45%) and had more blood transfusion units (2641ccs), all P<0.050. The multivariate regression determined a combination of a baseline DRAM score in the 75th percentile, having arthritis and kidney disease, a baseline right lower extremity motor score ≤3, cSVA >65 mm, C2 slope >30.2°, CTPA >5.5° for an R2 value of 0.535 (P<0.001).

Conclusions

When addressing adult spine deformities, poor outcomes tends to occur in severely comorbid patients with major baseline psychological distress scores, poor neurologic function, and concomitant cervical malalignment.

Department

Description

Provenance

Citation

Published Version (Please cite this version)

10.1097/brs.0000000000004778

Publication Info

Passias, Peter G, Katherine E Pierce, Pooja Dave, Renaud Lafage, Virginie Lafage, Andrew J Schoenfeld, Breton Line, Juan Uribe, et al. (2023). When Not to Operate in Spinal Deformity: Identifying Subsets of Patients with Simultaneous Clinical Deterioration, Major Complications, and Reoperation. Spine. 10.1097/brs.0000000000004778 Retrieved from https://hdl.handle.net/10161/28763.

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Scholars@Duke

Shaffrey

Christopher Ignatius Shaffrey

Professor of Orthopaedic Surgery

I have more than 25 years of experience treating patients of all ages with spinal disorders. I have had an interest in the management of spinal disorders since starting my medical education. I performed residencies in both orthopaedic surgery and neurosurgery to gain a comprehensive understanding of the entire range of spinal disorders. My goal has been to find innovative ways to manage the range of spinal conditions, straightforward to complex. I have a focus on managing patients with complex spinal disorders. My patient evaluation and management philosophy is to provide engaged, compassionate care that focuses on providing the simplest and least aggressive treatment option for a particular condition. In many cases, non-operative treatment options exist to improve a patient’s symptoms. I have been actively engaged in clinical research to find the best ways to manage spinal disorders in order to achieve better results with fewer complications.


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