Comparative Analysis of Clinical Outcome and Perioperative Complications in Primary vs. Revision Adult Scoliosis Surgery

Object Appreciation of the optimal management of skeletally mature patients with spinal deformities requires understanding of the natural history of the disease relative to expected outcomes of surgical intervention. Appropriate outcome measures are necessary to define the surgical treatment. Unfortunately, the literature lacks prospective randomized data. The majority of published series report outcomes of a particular surgical approach, procedure, or surgeon. The purpose of the current study was to systematically review the present spine deformity literature and assess the available data on clinical and radiographic outcome measurements. Methods A systematic review of MEDLINE and PubMed databases was performed to identify articles published from 1950 to the present using the following key words: “adult scoliosis surgery,” “adult spine deformity surgery,” “outcomes,” and “complications.” Exclusion criteria included follow-up shorter than 2 years and mean patient age younger than 18 years. Data on major curve (coronal scoliosis or lumbar lordosis Cobb angle as reported), major curve correction, Oswestry Disability Index (ODI) scores, Scoliosis Research Society (SRS) instrument scores, complications, and pseudarthroses were recorded. Results Forty-nine articles were obtained and included in this review; 3299 patient data points were analyzed. The mean age was 47.7 years, and the mean follow-up period was 3.6 years. The average major curve correction was 26.6° (for 2188 patients); for 2129 patients, it was possible to calculate average curve reduction as a percentage (40.7%). The mean total ODI was 41.2 (for 1289 patients), and the mean postoperative reduction in ODI was 15.7 (for 911 patients). The mean SRS-30 equivalent score was 97.1 (for 1700 patients) with a mean postoperative decrease of 23.1 (for 999 patients). There were 897 reported complications for 2175 patients (41.2%) and 319 pseudarthroses for 2469 patients (12.9%). Conclusions Surgery for adult scoliosis is associated with improvement in radiographic and clinical outcomes at a minimum 2-year follow-up. Perioperative morbidity includes an approximately 13% risk of pseudarthrosis and a greater than 40% incidence of perioperative adverse events. Incidence of perioperative complications is substantial and must be considered when deciding optimal disease management. Although the quality of published studies in this area has improved, particularly in the last few years, the current review highlights the lack of routine use of standardized outcomes measures and assessment in the adult scoliosis literature.

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Relevance of comorbidities and antithrombotic medication as risk factors for reoperation in patients with chronic subdural hematoma

Neurosurgical Review ◽

10.1007/s10143-021-01537-x ◽

2021 ◽

Author(s):

Alexander Younsi ◽

Lennart Riemann ◽

Cleo Habel ◽

Jessica Fischer ◽

Christopher Beynon ◽

...

Keyword(s):

Clinical Outcome ◽

Multivariate Analyses ◽

Independent Predictor ◽

Perioperative Complications ◽

Chronic Subdural Hematoma ◽

Western Society ◽

Increased Risk ◽

Surgical Evacuation ◽

Antithrombotic Medication ◽

Univariate Analyses

AbstractIn an aging Western society, the incidence of chronic subdural hematomas (cSDH) is continuously increasing. In this study, we reviewed our clinical management of cSDH patients and identified predictive factors for the need of reoperation due to residual or recurrent hematomas with a focus on the use of antithrombotic drugs. In total, 623 patients who were treated for cSDH with surgical evacuation between 2006 and 2016 at our department were retrospectively analyzed. Clinical and radiological characteristics and laboratory parameters were investigated as possible predictors of reoperation with univariate and multivariate analyses. Additionally, clinical outcome measures were compared between patients on anticoagulants, on antiplatelets, and without antithrombotic medication. In univariate analyses, patients on anticoagulants and antiplatelets presented significantly more often with comorbidities, were significantly older, and their risk for perioperative complications was significantly increased. Nevertheless, their clinical outcome was comparable to that of patients without antithrombotics. In multivariate analysis, only the presence of comorbidities, but not antithrombotics, was an independent predictor for the need for reoperations. Patients on antithrombotics do not seem to necessarily have a significantly increased risk for residual hematomas or rebleeding requiring reoperation after cSDH evacuation. More precisely, the presence of predisposing comorbidities might be a key independent risk factor for reoperation. Importantly, the clinical outcomes after surgical evacuation of cSDH are comparable between patients on anticoagulants, antiplatelets, and without antithrombotics.

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Perioperative Complications And Risk Factors In Degenerative Lumbar Scoliosis Surgery For Patients Older Than 70 Years Of Age

Clinical Interventions in Aging ◽

10.2147/cia.s218204 ◽

2019 ◽

Vol Volume 14 ◽

pp. 2195-2203

Author(s):

Jun-zhe Ding ◽

Chao Kong ◽

Xiang-yao Sun ◽

Shi-bao Lu

Keyword(s):

Risk Factors ◽

Perioperative Complications ◽

Degenerative Lumbar Scoliosis ◽

Scoliosis Surgery ◽

Lumbar Scoliosis

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Kickstand Rod Technique for Correcting Coronal Imbalance in Adult Scoliosis: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opz306 ◽

2019 ◽

Vol 19 (2) ◽

pp. E163-E164 ◽

Cited By ~ 1

Author(s):

Thomas J Buell ◽

Avery L Buchholz ◽

Marcus D Mazur ◽

Jeffrey P Mullin ◽

Ching-Jen Chen ◽

...

Keyword(s):

Functional Outcomes ◽

Adult Scoliosis ◽

Scoliosis Surgery ◽

Major Curve ◽

Coronal Imbalance ◽

Medical Publication ◽

Alignment Correction ◽

Iliac Screw ◽

Coronal Malalignment ◽

The Impact

Abstract Restoration of spinal alignment and balance is a major goal of adult scoliosis surgery. In the past, sagittal alignment has been emphasized and was shown to have the greatest impact on functional outcomes. However, recent evidence suggests the impact of coronal imbalance on pain and functional outcomes has likely been underestimated.1,2 In addition, iatrogenic coronal imbalance may be common and frequently results from inadequate correction of the lumbosacral fractional curve.2,3 The “kickstand rod” is a recently described technique to achieve and maintain significant coronal-plane correction.4 Also, of secondary benefit, the kickstand rod may function as an accessory supplemental rod to offload stress and bolster primary instrumentation. This may reduce occurrence of rod fracture (RF) or pseudarthrosis (PA).5 Briefly, this technique involves positioning the kickstand rod on the side of coronal imbalance (along the major curve concavity or fractional curve convexity in our video demonstration). The kickstand rod spans the thoracolumbar junction proximally to the pelvis distally and is secured with an additional iliac screw placed just superior to the primary iliac screw. By using the iliac wing as a base, powerful distraction forces can reduce the major curve to achieve more normal coronal balance. This operative video illustrates the technical nuances of utilizing the kickstand rod technique for correction of severe lumbar scoliosis and coronal malalignment in a 60-yr-old male patient. Alignment correction was achieved and maintained without evidence of RF/PA after nearly 6 mo postoperatively. The patient gave informed consent for surgery and to use imaging for medical publication.

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