Lower Satisfaction After Adult Spinal Deformity Surgery in Japan Than in the United States Despite Similar SRS-22 Pain and Function Scores

Abstract Adult spinal deformity (ASD) has gained significant attention over the past decade with improvements in diagnostic tools, classification schemes, and surgical technique. The demographics of the aging population in the United States are undergoing a fundamental shift as medical care advances and life expectancy increases. The “baby boomers” represent the fastest growing demographic in the United States and by 2050, the number of individuals 65 yr and older is projected to reach 89 million, more than double its current size. Based on current prevalence estimates there are approximately 27.5 million elderly individuals with some form of spinal deformity, which will place a significant burden on our health care systems. Rates of surgery for ASD and case complexity are both increasing, with concomitant increase in the cost of deformity care. At the same time, patients are more medically complex with increasing number of comorbidities that result in increased surgical risk and complication profiles. This review aims to highlight recent trends in the epidemiology and socioeconomic patterns in surgery for ASD.

Download Full-text

P79. Prevalence and surgical outcomes of primary severe sagittal plane deformity (pSPD) in adult spinal deformity (ASD) surgery: comparison between Japan and the United States

The Spine Journal ◽

10.1016/j.spinee.2020.05.477 ◽

2020 ◽

Vol 20 (9) ◽

pp. S184-S185

Author(s):

Mitsuru Yagi ◽

Christopher P. Ames ◽

Naobumi Hosogane ◽

Justin S. Smith ◽

Christopher I. Shaffrey ◽

...

Keyword(s):

United States ◽

Spinal Deformity ◽

Surgical Outcomes ◽

Sagittal Plane ◽

Adult Spinal Deformity ◽

The United States ◽

Plane Deformity

Download Full-text

Marked Increase in Spinal Deformity Surgery Throughout the United States

Spine ◽

10.1097/brs.0000000000004041 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Alexander Beschloss ◽

Christina Dicindio ◽

Joseph Lombardi ◽

Arya Varthi ◽

Ali Ozturk ◽

...

Keyword(s):

United States ◽

Spinal Deformity ◽

The United States ◽

Spinal Deformity Surgery

Download Full-text

Development and validation of risk stratification models for adult spinal deformity surgery

Journal of Neurosurgery Spine ◽

10.3171/2019.3.spine181452 ◽

2019 ◽

Vol 31 (4) ◽

pp. 587-599 ◽

Cited By ~ 4

Author(s):

Ferran Pellisé ◽

Miquel Serra-Burriel ◽

Justin S. Smith ◽

Sleiman Haddad ◽

Michael P. Kelly ◽

...

Keyword(s):

Spinal Deformity ◽

Adult Spinal Deformity ◽

The United States ◽

Adverse Outcomes ◽

High Rate ◽

Prognostic Models ◽

Time To Event ◽

European Continent ◽

Event Risk ◽

Risk Estimates

OBJECTIVEAdult spinal deformity (ASD) surgery has a high rate of major complications (MCs). Public information about adverse outcomes is currently limited to registry average estimates. The object of this study was to assess the incidence of adverse events after ASD surgery, and to develop and validate a prognostic tool for the time-to-event risk of MC, hospital readmission (RA), and unplanned reoperation (RO).METHODSTwo models per outcome, created with a random survival forest algorithm, were trained in an 80% random split and tested in the remaining 20%. Two independent prospective multicenter ASD databases, originating from the European continent and the United States, were queried, merged, and analyzed. ASD patients surgically treated by 57 surgeons at 23 sites in 5 countries in the period from 2008 to 2016 were included in the analysis.RESULTSThe final sample consisted of 1612 ASD patients: mean (standard deviation) age 56.7 (17.4) years, 76.6% women, 10.4 (4.3) fused vertebral levels, 55.1% of patients with pelvic fixation, 2047.9 observation-years. Kaplan-Meier estimates showed that 12.1% of patients had at least one MC at 10 days after surgery; 21.5%, at 90 days; and 36%, at 2 years. Discrimination, measured as the concordance statistic, was up to 71.7% (95% CI 68%–75%) in the development sample for the postoperative complications model. Surgical invasiveness, age, magnitude of deformity, and frailty were the strongest predictors of MCs. Individual cumulative risk estimates at 2 years ranged from 3.9% to 74.1% for MCs, from 3.17% to 44.2% for RAs, and from 2.67% to 51.9% for ROs.CONCLUSIONSThe creation of accurate prognostic models for the occurrence and timing of MCs, RAs, and ROs following ASD surgery is possible. The presented variability in patient risk profiles alongside the discrimination and calibration of the models highlights the potential benefits of obtaining time-to-event risk estimates for patients and clinicians.

Download Full-text

Characteristics of false-positive alerts on transcranial motor evoked potential monitoring during pediatric scoliosis and adult spinal deformity surgery: an “anesthetic fade” phenomenon

Journal of Neurosurgery Spine ◽

10.3171/2019.9.spine19814 ◽

2020 ◽

Vol 32 (3) ◽

pp. 423-431 ◽

Cited By ~ 3

Author(s):

Hiroki Ushirozako ◽

Go Yoshida ◽

Tomohiko Hasegawa ◽

Yu Yamato ◽

Tatsuya Yasuda ◽

...

Keyword(s):

Spinal Deformity ◽

False Positive ◽

Adult Spinal Deformity ◽

False Positive Rate ◽

Multivariate Logistic Regression Analysis ◽

Motor Evoked Potential ◽

Scoliosis Surgery ◽

True Negative ◽

Duration Of Surgery ◽

Spinal Deformity Surgery

OBJECTIVETranscranial motor evoked potential (TcMEP) monitoring may be valuable for predicting postoperative neurological complications with a high sensitivity and specificity, but one of the most frequent problems is the high false-positive rate. The purpose of this study was to clarify the differences in the risk factors for false-positive TcMEP alerts seen when performing surgery in patients with pediatric scoliosis and adult spinal deformity and to identify a method to reduce the false-positive rate.METHODSThe authors retrospectively analyzed 393 patients (282 adult and 111 pediatric patients) who underwent TcMEP monitoring while under total intravenous anesthesia during spinal deformity surgery. They defined their cutoff (alert) point as a final TcMEP amplitude of ≤ 30% of the baseline amplitude. Patients with false-positive alerts were classified into one of two groups: a group with pediatric scoliosis and a group with adult spinal deformity.RESULTSThere were 14 cases of false-positive alerts (13%) during pediatric scoliosis surgery and 62 cases of false-positive alerts (22%) during adult spinal deformity surgery. Compared to the true-negative cases during adult spinal deformity surgery, the false-positive cases had a significantly longer duration of surgery and greater estimated blood loss (both p < 0.001). Compared to the true-negative cases during pediatric scoliosis surgery, the false-positive cases had received a significantly higher total fentanyl dose and a higher mean propofol dose (0.75 ± 0.32 mg vs 0.51 ± 0.18 mg [p = 0.014] and 5.6 ± 0.8 mg/kg/hr vs 5.0 ± 0.7 mg/kg/hr [p = 0.009], respectively). A multivariate logistic regression analysis revealed that the duration of surgery (1-hour difference: OR 1.701; 95% CI 1.364–2.120; p < 0.001) was independently associated with false-positive alerts during adult spinal deformity surgery. A multivariate logistic regression analysis revealed that the mean propofol dose (1-mg/kg/hr difference: OR 3.117; 95% CI 1.196–8.123; p = 0.020), the total fentanyl dose (0.05-mg difference; OR 1.270; 95% CI 1.078–1.497; p = 0.004), and the duration of surgery (1-hour difference: OR 2.685; 95% CI 1.131–6.377; p = 0.025) were independently associated with false-positive alerts during pediatric scoliosis surgery.CONCLUSIONSLonger duration of surgery and greater blood loss are more likely to result in false-positive alerts during adult spinal deformity surgery. In particular, anesthetic doses were associated with false-positive TcMEP alerts during pediatric scoliosis surgery. The authors believe that false-positive alerts during pediatric scoliosis surgery, in particular, are caused by “anesthetic fade.”

Download Full-text