Improvement and International Validation of the Predictive Probability of the Patient Demographics, Radiographic Index and Surgical Invasiveness for Mechanical Failure (PRISM) Model for Preventive Procedures in Adult 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.”

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Validity of the global alignment proportion (GAP) score in predicting mechanical complications after adult spinal deformity surgery in elderly patients

European Spine Journal ◽

10.1007/s00586-021-06734-2 ◽

2021 ◽

Author(s):

Dae-Woong Ham ◽

Ho-Joong Kim ◽

Jae Heouk Choi ◽

Jiwon Park ◽

Junpyo Lee ◽

...

Keyword(s):

Elderly Patients ◽

Spinal Deformity ◽

Adult Spinal Deformity ◽

Global Alignment ◽

Mechanical Complications ◽

Spinal Deformity Surgery ◽

Surgery In Elderly

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Pre-existing vertebral fracture is a risk factor for postoperative proximal junctional fracture after adult spinal deformity surgery: A propensity score-matched analysis

Journal of Orthopaedic Science ◽

10.1016/j.jos.2021.01.003 ◽

2021 ◽

Author(s):

Junya Katayanagi ◽

Takahiro Iida ◽

Atsuki Hayamizu ◽

Kazuyuki Matsumoto ◽

Hirokazu Furukawa ◽

...

Keyword(s):

Risk Factor ◽

Vertebral Fracture ◽

Propensity Score ◽

Spinal Deformity ◽

Adult Spinal Deformity ◽

Spinal Deformity Surgery

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Lowest Instrumented Vertebra Selection to S1 or Ilium Versus L4 or L5 in Adult Spinal Deformity: Factors for Consideration in 349 Patients With a Mean 46-Month Follow-Up

Global Spine Journal ◽

10.1177/21925682211009178 ◽

2021 ◽

pp. 219256822110091

Author(s):

Yu-Cheng Yao ◽

Han Jo Kim ◽

Mathieu Bannwarth ◽

Justin Smith ◽

Shay Bess ◽

...

Keyword(s):

Spinal Deformity ◽

Sagittal Alignment ◽

Adult Spinal Deformity ◽

Operating Time ◽

Patient Demographics ◽

Lowest Instrumented Vertebra ◽

Related Quality ◽

Health Related

Study Design: Retrospective cohort study. Objective: To compare the outcomes of patients with adult spinal deformity (ASD) following spinal fusion with the lowest instrumented vertebra (LIV) at L4/L5 versus S1/ilium. Methods: A multicenter ASD database was evaluated. Patients were categorized into 2 groups based on LIV levels—groups L (fusion to L4/L5) and S (fusion to S1/ilium). Both groups were propensity matched by age and preoperative radiographic alignments. Patient demographics, operative details, radiographic parameters, revision rates, and health-related quality of life (HRQOL) scores were compared. Results: Overall, 349 patients had complete data, with a mean follow-up of 46 months. Patients in group S (n = 311) were older and had larger sagittal and coronal plane deformities than those in group L (n = 38). After matching, 28 patients were allocated to each group with similar demographic, radiographic, and clinical parameters. Sagittal alignment restoration at postoperative week 6 was significantly better in group S than in group L, but it was similar in both groups at the 2-year follow-up. Fusion to S1/ilium involved a longer operating time, higher PJK rates, and greater PJK angles than that to L4/L5. There were no significant differences in the complication and revision rates between the groups. Both groups showed significant improvements in HRQOL scores. Conclusions: Fusion to S1/ilium had better sagittal alignment restoration at postoperative week 6 and involved higher PJK rates and greater PJK angles than that to L4/L5. The clinical outcomes and rates of revision surgery and complications were similar between the groups.

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