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

dc.contributor.author

Passias, Peter G

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Pierce, Katherine E

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Dave, Pooja

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Lafage, Renaud

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Lafage, Virginie

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Schoenfeld, Andrew J

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Line, Breton

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Uribe, Juan

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Hostin, Richard

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Daniels, Alan

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Hart, Robert

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Burton, Douglas

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Kim, Han Jo

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Mundis, Gregory M

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Eastlack, Robert

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Diebo, Bassel G

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Gum, Jeffrey L

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Shaffrey, Christopher

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Schwab, Frank

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Ames, Christopher P

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Smith, Justin S

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Bess, Shay

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Klineberg, Eric

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Gupta, Munish C

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Hamilton, D Kojo

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International Spine Study Group

dc.date.accessioned

2023-08-23T18:48:37Z

dc.date.available

2023-08-23T18:48:37Z

dc.date.issued

2023-07

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2023-08-23T18:48:37Z

dc.description.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.
dc.identifier

00007632-990000000-00419

dc.identifier.issn

0362-2436

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1528-1159

dc.identifier.uri

https://hdl.handle.net/10161/28763

dc.language

eng

dc.publisher

Ovid Technologies (Wolters Kluwer Health)

dc.relation.ispartof

Spine

dc.relation.isversionof

10.1097/brs.0000000000004778

dc.subject

International Spine Study Group

dc.title

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

dc.type

Journal article

duke.contributor.orcid

Shaffrey, Christopher|0000-0001-9760-8386

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Duke

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School of Medicine

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Clinical Science Departments

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Orthopaedic Surgery

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Neurosurgery

pubs.publication-status

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