Complications in adult spinal deformity surgery: an analysis of minimally invasive, hybrid, and open surgical techniques.

dc.contributor.author

Uribe, Juan S

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Deukmedjian, Armen R

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Mummaneni, Praveen V

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Fu, Kai-Ming G

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Mundis, Gregory M

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Okonkwo, David O

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Kanter, Adam S

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Eastlack, Robert

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Wang, Michael Y

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Anand, Neel

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Fessler, Richard G

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La Marca, Frank

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Park, Paul

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Lafage, Virginie

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Deviren, Vedat

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Bess, Shay

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Shaffrey, Christopher I

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International Spine Study Group

dc.date.accessioned

2023-08-29T23:10:34Z

dc.date.available

2023-08-29T23:10:34Z

dc.date.issued

2014-05

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2023-08-29T23:10:33Z

dc.description.abstract

Object

It is hypothesized that minimally invasive surgical techniques lead to fewer complications than open surgery for adult spinal deformity (ASD). The goal of this study was to analyze matched patient cohorts in an attempt to isolate the impact of approach on adverse events.

Methods

Two multicenter databases queried for patients with ASD treated via surgery and at least 1 year of follow-up revealed 280 patients who had undergone minimally invasive surgery (MIS) or a hybrid procedure (HYB; n = 85) or open surgery (OPEN; n = 195). These patients were divided into 3 separate groups based on the approach performed and were propensity matched for age, preoperative sagittal vertebral axis (SVA), number of levels fused posteriorly, and lumbar coronal Cobb angle (CCA) in an attempt to neutralize these patient variables and to make conclusions based on approach only. Inclusion criteria for both databases were similar, and inclusion criteria specific to this study consisted of an age > 45 years, CCA > 20°, 3 or more levels of fusion, and minimum of 1 year of follow-up. Patients in the OPEN group with a thoracic CCA > 75° were excluded to further ensure a more homogeneous patient population.

Results

In all, 60 matched patients were available for analysis (MIS = 20, HYB = 20, OPEN = 20). Blood loss was less in the MIS group than in the HYB and OPEN groups, but a significant difference was only found between the MIS and the OPEN group (669 vs 2322 ml, p = 0.001). The MIS and HYB groups had more fused interbody levels (4.5 and 4.1, respectively) than the OPEN group (1.6, p < 0.001). The OPEN group had less operative time than either the MIS or HYB group, but it was only statistically different from the HYB group (367 vs 665 minutes, p < 0.001). There was no significant difference in the duration of hospital stay among the groups. In patients with complete data, the overall complication rate was 45.5% (25 of 55). There was no significant difference in the total complication rate among the MIS, HYB, and OPEN groups (30%, 47%, and 63%, respectively; p = 0.147). No intraoperative complications were reported for the MIS group, 5.3% for the HYB group, and 25% for the OPEN group (p < 0.03). At least one postoperative complication occurred in 30%, 47%, and 50% (p = 0.40) of the MIS, HYB, and OPEN groups, respectively. One major complication occurred in 30%, 47%, and 63% (p = 0.147) of the MIS, HYB, and OPEN groups, respectively. All patients had significant improvement in both the Oswestry Disability Index (ODI) and visual analog scale scores after surgery (p < 0.001), although the MIS group did not have significant improvement in leg pain. The occurrence of complications had no impact on the ODI.

Conclusions

Results in this study suggest that the surgical approach may impact complications. The MIS group had significantly fewer intraoperative complications than did either the HYB or OPEN groups. If the goals of ASD surgery can be achieved, consideration should be given to less invasive techniques.
dc.identifier.issn

1092-0684

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1092-0684

dc.identifier.uri

https://hdl.handle.net/10161/28803

dc.language

eng

dc.publisher

Journal of Neurosurgery Publishing Group (JNSPG)

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Neurosurgical focus

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10.3171/2014.3.focus13534

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International Spine Study Group

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Humans

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Postoperative Complications

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Treatment Outcome

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Spinal Fusion

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Retrospective Studies

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Aged

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Aged, 80 and over

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Middle Aged

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Female

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Male

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Intervertebral Disc Degeneration

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Minimally Invasive Surgical Procedures

dc.title

Complications in adult spinal deformity surgery: an analysis of minimally invasive, hybrid, and open surgical techniques.

dc.type

Journal article

duke.contributor.orcid

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

pubs.begin-page

E15

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5

pubs.organisational-group

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

Published

pubs.volume

36

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