Mechanical complications in adult spinal deformity and the effect of restoring the spinal shapes according to the Roussouly classification: a multicentric study

Abstract Purpose To evaluate the incidence of mechanical complications in patients with adult spine deformity (ASD) treated by restoring the normal shape according to the Roussouly classification. Methods This is a retrospective multicentric study with a minimum follow-up of 2 years. Patients operated on with fusion for ASD (minimum performed fusion: L2 to sacrum) were included. Patients with a history of previous spinal fusion of more than three levels were excluded. Spinal and pelvic parameters were measured on the preoperative and the immediate postoperative follow-up. All mechanical complications were recorded. Results A total of 290 patients met the criteria of inclusion with a minimum follow-up of 2 years. Mechanical complications occurred in 30.4% of the cohort. The most common complication was PJK with an incidence of 18% while nonunion or instrumentation failure (rod breakage, implant failure) occurred in 12.4%. 66% of the patients were restored to the normal shape according to the Roussouly classification based on their PI and had a mechanical complication rate of 22.5%, whereas the remaining 34% of patients had a complication rate of 46.8% (p < 0.001). The relative risk for developing a mechanical complication if the algorithm was not met was 3 (CI 1.5–4.3; p < 0.001) Conclusion In the recent literature, there are no clear guidelines for ASD correction. Restoring the sagittal spinal contour to the normal shapes of Roussouly according to the PI could serve as a guideline for ASD treatment. Ignoring this algorithm has a threefold risk of increased mechanical complications. We recommend this algorithm for treatment of ASD. Level of evidence IV cross-sectional observational study. Graphic abstract These slides can be retrieved under Electronic Supplementary Material.

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Mechanical Complications in Adult Spine Deformity Surgery: Retrospective Evaluation of Incidence, Clinical Impact and Risk Factors in a Single-Center Large Series

Journal of Clinical Medicine ◽

10.3390/jcm10091811 ◽

2021 ◽

Vol 10 (9) ◽

pp. 1811

Author(s):

Giuseppe Barone ◽

Fabrizio Giudici ◽

Nicolò Martinelli ◽

Domenico Ravier ◽

Stefano Muzzi ◽

...

Keyword(s):

Risk Factors ◽

Surgical Techniques ◽

Clinical Impact ◽

Spine Deformity ◽

Mechanical Complication ◽

Single Center ◽

Mechanical Complications ◽

Adult Spine Deformity ◽

Adult Spine

The advancement of deformity-specific implants and surgical techniques has improved the surgical treatment of Adult Spine Deformity (ASD), allowing surgeons to treat more complex deformities. Simultaneously, high rates of medical and surgical complications have been reported. The aim of this study is to describe the risk factors, the rate and the clinical impact of mechanical complications in ASD surgery. A retrospective review of a large, single-center database of consecutive ASD patients was conducted. Inclusion criteria were as follows: Cobb coronal curve > 20° or alteration of at least one of sagittal vertical axis (SVA > 40 mm), thoracic kyphosis (TK > 60°), pelvic tilt (PT > 20°) and pelvic incidence minus lumbar lordosis mismatch (PI-LL > 10°), at least four levels of posterior instrumented fusion and 2-year follow-up. At the baseline and at each follow-up end point, the authors collected clinical and radiographic outcomes and recorded any mechanical complications that occurred. One hundred and two patients were enrolled. Clinical outcomes significantly were improved at the last follow-up (mean 40.9 months). Postoperative mechanical complications occurred in 15 patients (14.7%); proximal junctional disease was the most common complication (60%) and the revision rate was 53.3%. Patients who experienced mechanical complications were older (61.2 vs. 54.8 years, p = 0.04); they had also a higher rate of pelvic fusion and posterior-only approach, a lower LL (−37.9 vs. −46.2, p = 0.02) and a higher PT (26.3 vs. 19.8, p = 0.009), TK (41.8 vs. 35.7, p = 0.05), PI–LL (12.9 vs. 5.4, p = 0.03) and Global Alignment and Proportion score (6.9 vs. 4.3, p = 0.01). This study showed a significant improvement in pain and disability after ASD surgery. Regarding the risk of developing a mechanical complication, not only postoperative radiographic parameters affected the risk but also patient age and surgical features.

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Does the Global Alignment and Proportion score overestimate mechanical complications after adult spinal deformity correction?

Journal of Neurosurgery Spine ◽

10.3171/2020.6.spine20538 ◽

2021 ◽

Vol 34 (1) ◽

pp. 96-102

Author(s):

Griffin R. Baum ◽

Alex S. Ha ◽

Meghan Cerpa ◽

Scott L. Zuckerman ◽

James D. Lin ◽

...

Keyword(s):

Spinal Deformity ◽

Adult Spinal Deformity ◽

External Validation ◽

Global Alignment ◽

Mechanical Complication ◽

Complication Rates ◽

Mechanical Complications ◽

Significant Difference ◽

Chi Square Analysis

OBJECTIVEThe goal of this study was to validate the Global Alignment and Proportion (GAP) score in a cohort of patients undergoing adult spinal deformity (ASD) surgery. The GAP score is a novel measure that uses sagittal parameters relative to each patient’s lumbosacral anatomy to predict mechanical complications after ASD surgery. External validation is required.METHODSAdult ASD patients undergoing > 4 levels of posterior fusion with a minimum 2-year follow-up were included. Six-week postoperative standing radiographs were used to calculate the GAP score, classified into a spinopelvic state as proportioned (P), moderately disproportioned (MD), or severely disproportioned (SD). A chi-square analysis, receiver operating characteristic curve, and Cochran-Armitage analysis were performed to assess the relationship between the GAP score and mechanical complications.RESULTSSixty-seven patients with a mean age of 52.5 years (range 18–75 years) and a mean follow-up of 2.04 years were included. Patients with < 2 years of follow-up were included only if they had an early mechanical complication. Twenty of 67 patients (29.8%) had a mechanical complication. The spinopelvic state breakdown was as follows: P group, 21/67 (31.3%); MD group, 23/67 (34.3%); and SD group, 23/67 (34.3%). Mechanical complication rates were not significantly different among all groups: P group, 19.0%; MD group, 30.3%; and SD group, 39.1% (χ2 = 1.70, p = 0.19). The rates of mechanical complications between the MD and SD groups (30.4% and 39.1%) were less than those observed in the original GAP study (MD group 36.4%–57.1% and SD group 72.7%–100%). Within the P group, the rates in this study were higher than in the original study (19.0% vs 4.0%, respectively).CONCLUSIONSThe authors found no statistically significant difference in the rate of mechanical complications between the P, MD, and SD groups. The current validation study revealed poor generalizability toward the authors’ patient population.

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Mechanical complications of central venous catheterisation in trauma patients

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2017.0022 ◽

2017 ◽

Vol 99 (5) ◽

pp. 390-393 ◽

Cited By ~ 17

Author(s):

J Odendaal ◽

VY Kong ◽

B Sartorius ◽

TY Liu ◽

YY Liu ◽

...

Keyword(s):

Complication Rate ◽

Guide Wire ◽

Junior Doctors ◽

Trauma Patients ◽

Mechanical Complication ◽

Central Venous ◽

Central Venous Catheterisation ◽

Mechanical Complications ◽

Trauma Service ◽

Catheter Dislodgement

INTRODUCTIONCentral venous catheterisation (CVC) is a commonly performed procedure in a wide variety of hospital settings and is associated with appreciable morbidity. There is a paucity of literature focusing on mechanical complications specifically in the trauma setting. The aim of our study was to determine the spectrum of mechanical complications in a high-volume trauma centre in a developing world setting where ultrasound guidance was not available.METHODSA retrospective study was performed analysing data from a four-year period at the Pietermaritzburg Metropolitan Trauma Service in South Africa.RESULTSA total of 178 mechanical complications (18%) occurred in 1,015 patients undergoing CVC: 117 pneumothoraces, 25 malpositions, 18 catheter dislodgements, 14 arterial cannulations, one air embolism, one chylothorax, one pleural cannulation and one retained guide-wire. The internal jugular vein (IJV) approach was associated with a higher overall complication rate than the subclavian vein (SCV) approach (24% vs. 13%, p<0.001). Pneumothorax (73% vs. 57%, p<0.001) and arterial cannulation (15% vs. 0%, p<0.001) were more common with the IJV. Catheter dislodgement (21% vs. 0%, p<0.001) was more common with the SCV. Junior doctors performed 66% of the CVCs and this was associated with a significantly higher complication rate (20% vs. 12%, p<0.001).CONCLUSIONSCVC carries appreciable morbidity, with pneumothorax being the most frequent mechanical complication. The SCV was the most commonly used approach at our institution. The majority of CVCs were performed by junior doctors and this was associated with a considerable complication rate.

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Successful microsurgical replantation of an amputated penis

Indian Journal of Plastic Surgery ◽

10.4103/0970-0358.182257 ◽

2016 ◽

Vol 49 (01) ◽

pp. 99-105 ◽

Cited By ~ 1

Author(s):

Sanchit Garg ◽

Shivprasad V. Date ◽

Arunesh Gupta ◽

Amresh S. Baliarsing

Keyword(s):

Standard Method ◽

Complication Rate ◽

Erectile Function ◽

Skin Necrosis ◽

Penile Shaft ◽

Level Of Evidence ◽

Cosmetic Appearance ◽

Microsurgical Techniques ◽

Penile Replantation

ABSTRACTPenile amputation is an uncommon injury for which immediate surgical replantation is warranted. Microsurgical replantation is the “standard” method for penile replantation. Early replantation yields a high success and low complication rate. We report a case of a 34-year-old male who presented with amputation at the proximal penile shaft which was successfully replanted using microsurgical techniques. Minor skin necrosis was noted post-operatively which was debrided and covered with skin graft. Follow-up at 6 months showed satisfactory cosmetic appearance, normal voiding, return of sensations and erectile function. The level of evidence was V.

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Partial Intraoperative Global Alignment and Proportion Scores Do Not Reliably Predict Postoperative Mechanical Failure in Adult Spinal Deformity Surgery

Global Spine Journal ◽

10.1177/2192568220935438 ◽

2020 ◽

pp. 219256822093543

Author(s):

Alex S. Ha ◽

Daniel Y. Hong ◽

Josephine R. Coury ◽

Meghan Cerpa ◽

Griffin Baum ◽

...

Keyword(s):

Logistic Regression ◽

Sagittal Plane ◽

Adult Spinal Deformity ◽

Mechanical Failure ◽

Global Alignment ◽

Mechanical Complications ◽

Plane Analysis ◽

Spinal Deformity Surgery ◽

Distribution Index

Study Design: Retrospective radiographic review. Objectives: The Global Alignment and Proportion (GAP) score allows sagittal plane analysis for deformity patients and may be predictive of mechanical complications. This study aims to assess the effectiveness of predicting mechanical failure based on partial intraoperative GAP (iGAP) scores. Methods: A retrospective radiographic review was performed on 48 deformity patients between July 2015 to January 2017 with a 2-year follow-up. Using the same methodology as the original GAP study, the partial iGAP score was calculated with the sum of the scores for age, relative lumbar lordosis (RLL), and lordosis distribution index (LDI). Therefore, the iGAP score (0-7) was grouped into proportional (0-2), mildly disproportionate (3-5), and severely disproportionate (6-7). Logistic regression was performed to assess the ability of the partial iGAP score to predict postoperative mechanical failure. Results: The mean iGAP for patients with a mechanical failure was 3.54, whereas the iGAP for those without a mechanical failure was 3.46 ( P = .90). The overall mechanical failure rate was 27.1%. The mechanical failures included 8 proximal junctional kyphosis, 7 rod fractures, and 1 rod slippage from the distal end of the construct. Logistic regression analysis revealed that the partial iGAP score was not able to predict postoperative mechanical failure (χ2 = 1.4; P = .49). Conclusion: The iGAP scores for RLL or LDI did not show any significant correlation to postoperative mechanical failure. Ultimately, the proposed partial iGAP score did not predict postoperative mechanical failure and thus, cannot be used as an intraoperative alignment assessment to avoid postoperative mechanical complications.

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Male sex may not be associated with worse outcomes in primary all-posterior adult spinal deformity surgery: a multicenter analysis

Neurosurgical FOCUS ◽

10.3171/2017.9.focus17475 ◽

2017 ◽

Vol 43 (6) ◽

pp. E9 ◽

Cited By ~ 4

Author(s):

David B. Bumpass ◽

Lawrence G. Lenke ◽

Jeffrey L. Gum ◽

Christopher I. Shaffrey ◽

Justin S. Smith ◽

...

Keyword(s):

Sex Differences ◽

Spinal Deformity ◽

Operative Time ◽

Adult Spinal Deformity ◽

Deformity Correction ◽

Spine Deformity ◽

Complication Rates ◽

Female Patients ◽

Male Patients

OBJECTIVEAdolescent spine deformity studies have shown that male patients require longer surgery and have greater estimated blood loss (EBL) and complications compared with female patients. No studies exist to support this relationship in adult spinal deformity (ASD). The purpose of this study was to investigate associations between sex and complications, deformity correction, and health-related quality of life (HRQOL) in patients with ASD. It was hypothesized that male ASD patients would have greater EBL, longer surgery, and more complications than female ASD patients.METHODSA multicenter ASD cohort was retrospectively queried for patients who underwent primary posterior-only instrumented fusions with a minimum of 5 levels fused. The minimum follow-up was 2 years. Primary outcomes were EBL, operative time, intra-, peri-, and postoperative complications, radiographic correction, and HRQOL outcomes (Oswestry Disability Index, SF-36, and Scoliosis Research Society-22r Questionnaire). Poisson multivariate regression was used to control for age, comorbidities, and levels fused.RESULTSNinety male and 319 female patients met the inclusion criteria. Male patients had significantly greater mean EBL (2373 ml vs 1829 ml, p = 0.01). The mean operative time, transfusion requirements, and final radiographic measurements did not differ between sexes. Similarly, changes in HRQOL showed no significant differences. Finally, there were no sex differences in the incidence of complications (total, major, or minor) at any time point after controlling for age, body mass index, comorbidities, and levels fused.CONCLUSIONSDespite higher EBL, male ASD patients did not experience more complications or require less deformity correction at the 2-year follow-up. HRQOL scores similarly showed no sex differences. These findings differ from adolescent deformity studies, and surgeons can counsel patients that sex is unlikely to influence the outcomes and complication rates of primary all-posterior ASD surgery.

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Safe and effective performance of pediatric spinal deformity surgery in patients unwilling to accept blood transfusion: a clinical study and review of literature

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04081-3 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Alexander Mihas ◽

Subaraman Ramchandran ◽

Sebastian Rivera ◽

Ali Mansour ◽

Jahangir Asghar ◽

...

Keyword(s):

Blood Transfusion ◽

Blood Loss ◽

Spinal Deformity ◽

Intraoperative Complications ◽

Spine Deformity ◽

Blood Conservation ◽

Level Of Evidence ◽

Estimated Blood Loss ◽

Spinal Deformity Surgery

Abstract Background Pediatric deformity surgery traditionally involves major blood loss. Patients refusing blood transfusion add extra clinical and medicolegal challenges; specifically the Jehovah’s witnesses population. The objective of this study is to review the safety and effectiveness of blood conservation techniques in patients undergoing pediatric spine deformity surgery who refuse blood transfusion. Methods After obtaining institutional review board approval, we retrospectively reviewed 20 consecutive patients who underwent spinal deformity surgery and refused blood transfusion at a single institution between 2014 and 2018. We collected pertinent preoperative, intraoperative and most recent clinical and radiological data with latest follow-up (minimum two-year follow-up). Results Twenty patients (13 females) with a mean age of 14.1 years were identified. The type of scoliotic deformities were adolescent idiopathic (14), juvenile idiopathic (1), neuromuscular (3) and congenital (2). The major coronal Cobb angle was corrected from 55.4° to 11.2° (80% correction, p < 0.001) at the latest follow-up. A mean of 11.4 levels were fused and 5.6 levels of Pontes osteotomies were performed. One patient underwent L1 hemivertebra resection and three patients had fusion to pelvis. Estimated blood loss, percent estimated blood volume loss, and cell saver returned averaged 307.9 mL, 8.5%, and 80 mL, respectively. Average operative time was 214 min. The average drop in hemoglobin after surgery was 2.9 g/dL. The length of hospital stay averaged 5.1 days. There were no intraoperative complications. Three postoperative complications were identified, none related to their refusal of transfusion. One patient had in-hospital respiratory complication, one patient developed a late infection, and one patient developed asymptomatic radiographic distal junctional kyphosis. Conclusions Blood conservation techniques allow for safe and effective spine deformity surgery in pediatric patients refusing blood transfusion without major anesthetic or medical complications, when performed by an experienced multidisciplinary team. Level of evidence Level IV.

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Clinical Outcomes of S2 Alar-Iliac (S2AI) Screw Technique in The Treatment of Severe Spinal Sagittal Imbalance: A Retrospective 2-Year Follow-Up Study

10.21203/rs.3.rs-1033808/v1 ◽

2021 ◽

Author(s):

Yao Zhao ◽

Beiyu Xu ◽

Longtao Qi ◽

Chunde Li ◽

Zhengrong Yu ◽

...

Keyword(s):

Lumbar Lordosis ◽

Adult Spinal Deformity ◽

Pearson Correlation ◽

Sacral Slope ◽

Sagittal Imbalance ◽

Global Alignment ◽

Mechanical Complications ◽

Group A ◽

Group B

Abstract Background The treatment of adult spinal deformity (ASD) remains a significant challenge, especially in elderly patients. This study aimed to evaluate the outcomes of the S2AI screw technique in the treatment of severe spinal sagittal imbalance with a minimum 2-year follow-up. Methods From January 2015 to December 2018, 23 patients with severe degenerative thoracolumbar kyphosis who underwent placement of S2AI screws for long segment fusion were retrospectively reviewed. Patients were divided into group A (no mechanical complications, 13 cases) and group B (with mechanical complications, 10 cases) according to the occurrence of mechanical complications at the last follow-up. Radiographic parameters were compared between groups preoperatively, 1 month postoperatively, and at the last follow-up. Risk factors for mechanical complications were analyzed. Results The incidence of mechanical complications was 43.5%, and the revision rate was 17.4%. At 1 month postoperatively, sagittal correction was better in group A than in group B (P<0.05). The lumbar lordosis (LL), pelvic incidence minus lumbar lordosis (PI-LL), T1 pelvic angle (TPA), and sagittal vertical axis (SVA) of both groups at the last follow-up were significantly different from corresponding values at 1 month postoperatively (P<0.05), and the sagittal correction was partially lost. Pearson correlation analysis revealed that the occurrence of mechanical complications was associated with sacral slope (SS), LL, PI-LL, and global alignment and proportion (GAP) score at 1 month postoperatively. Conclusion A high incidence of mechanical complications was observed in long-segment corrective surgery with the S2AI screw technique for severe spinal sagittal imbalance. Inadequate sagittal correction is a risk factor for the development of mechanical complications.

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Safe and Effective Performance of Pediatric Spinal Deformity Surgery in Patients Unwilling to Accept Blood Transfusion: A Clinical Study and Review of Literature

10.21203/rs.3.rs-89183/v1 ◽

2020 ◽

Author(s):

Alexander Mihas ◽

Ramchandran Subaraman ◽

Sebastian Rivera ◽

Ali Mansour ◽

Jahangir Asghar ◽

...

Keyword(s):

Blood Transfusion ◽

Blood Loss ◽

Spinal Deformity ◽

Intraoperative Complications ◽

Spine Deformity ◽

Blood Conservation ◽

Level Of Evidence ◽

Estimated Blood Loss ◽

Spinal Deformity Surgery

Abstract Background: Pediatric deformity surgery traditionally involves major blood loss. Patients refusing blood transfusion add extra clinical and medicolegal challenges; specifically the Jehovah’s witnesses population. The objective of this study is to review the safety and effectiveness of blood conservation techniques in patients undergoing pediatric spine deformity surgery who refuse blood transfusion Methods: After obtaining institutional review board approval, we retrospectively reviewed 20 consecutive patients who underwent spinal deformity surgery and refused blood transfusion at a single institution between 2014 and 2018.We collected pertinent preoperative, intraoperative and most recent clinical and radiological data with latest follow-up (minimum two-year follow-up).Results: Twenty patients (13 females) with a mean age of 14.1 years were identified. The type of scoliotic deformities were adolescent idiopathic (15), neuromuscular (3) and congenital (2). The major coronal Cobb angle was corrected from 55.40 to 11.20 (80% correction, p< 0.001) at the latest follow-up. A mean of 11.4 levels were fused, 5.6 levels of Pontes osteotomies and 2.8 levels of thoracoplasty performed. 1 patient underwent L1 VCR and 3 patients had fusion to pelvis. Estimated blood loss and cell saver returned an average of 307.9 ml and 80ml, respectively. Operative times average at 214 min. The average drop in hemoglobin after surgery was 2.1mg/dl. The length of hospital stay averaged 5.1 days. There were no intraoperative complications. Three postoperative compilations were identified, none related to their refusal of transfusion. One patient had in-hospital respiratory complication, one patient developed a late infection, and one patient developed asymptomatic radiographic distal junctional kyphosis.Conclusions: Blood conservation techniques allow safe and effective spine deformity surgery in pediatric patients refusing blood transfusion without major anesthetic or medical complications.Level of Evidence: Level IV.

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