scholarly journals Sagittal alignment changes and postoperative complications after adult spinal deformity surgery in patients with Parkinson’s disease: A multi-institutional retrospective study

2020 ◽  
Author(s):  
Atsuyuki Kawabata ◽  
Toshitaka Yoshii ◽  
Kenichiro Sakai ◽  
Takashi Hirai ◽  
Masato Yuasa ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Postoperative Complications ◽  
Spinal Deformity ◽  
Revision Surgery ◽  
Adult Spinal Deformity ◽  
Sacral Slope ◽  
Loss Of Correction ◽  
Mechanical Complications

Abstract Background: Parkinson’s disease (PD) has been reported to increase the risk of postoperative complications in patients with adult spinal deformity (ASD). However, those reports are limited, and few have made direct comparisons with patients who do not have PD.Methods: We retrospectively reviewed all surgically treated patients with ASD and at least 2 years of follow-up. Among them, 27 had PD (PD(+) group). Clinical data were collected on early and late postoperative complications and revision surgery. Radiographic parameters were evaluated before and immediately after surgery and at final follow-up, including sagittal vertical axis (SVA), thoracic kyphosis, lumbar lordosis, sacral slope, and pelvic tilt. From the same database, we also retrieved 206 controls without PD (PD(−) group) matched for age, sex, and body mass index.Results: For early complications, the PD(+) group showed a higher rate of delirium than the PD(−) group. Deep vein thrombosis and pulmonary embolism rates tended to be higher in the PD(+) group. For late complications, the rate of pseudarthrosis was significantly higher in the PD(+) group. Rates of rod failure and revision surgery due to mechanical complications also tended to be higher, but not significantly, in the PD(+) group (p = 0.17, p = 0.13, respectively). SVA at final follow-up and loss of correction in SVA were significantly higher in the PD(+) group.Conclusion: Extra attention should be paid to perioperative complications, especially delirium and thrombosis, in PD patients undergoing surgery for ASD. Furthermore, loss of correction and rate of revision surgery due to mechanical complications were higher in these patients.

Sagittal alignment changes and postoperative complications following surgery for adult spinal deformity in patients with Parkinson’s disease: a multi-institutional retrospective cohort study

2020 ◽  
Author(s):  
Atsuyuki Kawabata ◽  
Toshitaka Yoshii ◽  
Kenichiro Sakai ◽  
Takashi Hirai ◽  
Masato Yuasa ◽  
...  
Keyword(s):  
Cohort Study ◽  
Postoperative Complications ◽  
Spinal Deformity ◽  
Revision Surgery ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Adult Spinal Deformity ◽  
Loss Of Correction ◽  
Radiographic Parameters

Abstract Background: Parkinson’s disease (PD) has been reported to increase the risk of postoperative complications in patients with adult spinal deformity (ASD). However, those studies are limited, and few have made direct comparisons with patients who do not have PD. Methods: A retrospective cohort study. We retrospectively reviewed all surgically treated ASD patients with at least a 2-year follow-up. Among them, 27 had PD (PD(+) group). Clinical data were collected on early and late postoperative complications as well as any revision surgery. Radiographic parameters were evaluated before and immediately after surgery and at final follow-up, including sagittal vertical axis (SVA), thoracic kyphosis, lumbar lordosis, sacral slope, and pelvic tilt. We compared the surgical outcomes and radiographic parameters of PD patients with those of non-PD patients. Results: For early complications, the PD(+) group demonstrated a higher rate of delirium than the PD(−) group. Deep vein thrombosis and pulmonary embolism rates tended to be higher in the PD(+) group. With regard to late complications, the rate of pseudarthrosis was significantly higher in the PD(+) group. Rates of rod failure and revision surgery due to mechanical complications also tended to be higher, but not significantly, in the PD(+) group ( p = 0.17, p = 0.13, respectively). SVA at final follow-up and loss of correction in SVA were significantly higher in the PD(+) group. Conclusion: Extra attention should be paid to perioperative complications, especially delirium and thrombosis, in PD patients undergoing surgery for ASD. Furthermore, loss of correction and rate of pseudarthrosis were greater in these patients.

scholarly journals Sagittal alignment changes and postoperative complications following surgery for adult spinal deformity in patients with Parkinson’s disease: a multi-institutional retrospective cohort study

2020 ◽  
Author(s):  
Atsuyuki Kawabata ◽  
Toshitaka Yoshii ◽  
Kenichiro Sakai ◽  
Takashi Hirai ◽  
Masato Yuasa ◽  
...  
Keyword(s):  
Cohort Study ◽  
Postoperative Complications ◽  
Spinal Deformity ◽  
Revision Surgery ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Adult Spinal Deformity ◽  
Loss Of Correction ◽  
Radiographic Parameters

Abstract Background: Parkinson’s disease (PD) has been reported to increase the risk of postoperative complications in patients with adult spinal deformity (ASD). However, those studies are limited, and few have made direct comparisons with patients who do not have PD.Methods: A retrospective cohort study. We retrospectively reviewed all surgically treated ASD patients with at least a 2-year follow-up. Among them, 27 had PD (PD(+) group). Clinical data were collected on early and late postoperative complications as well as any revision surgery. Radiographic parameters were evaluated before and immediately after surgery and at final follow-up, including sagittal vertical axis (SVA), thoracic kyphosis, lumbar lordosis, sacral slope, and pelvic tilt. We compared the surgical outcomes and radiographic parameters of PD patients with those of non-PD patients.Results: For early complications, the PD(+) group demonstrated a higher rate of delirium than the PD(−) group. With regard to late complications, the rate of radiological pseudarthrosis was significantly higher in the PD(+) group. Rates of rod failure and revision surgery due to mechanical complications also tended to be higher, but not significantly, in the PD(+) group (p = 0.17, p = 0.13, respectively). SVA at final follow-up and loss of correction in SVA were significantly higher in the PD(+) group.Conclusion: Extra attention should be paid to perioperative complications, especially delirium, in PD patients undergoing surgery for ASD. Furthermore, loss of correction and rate of radiological pseudarthrosis were greater in these patients.

scholarly journals Sagittal alignment changes and postoperative complications following surgery for adult spinal deformity in patients with Parkinson’s disease: a multi-institutional retrospective cohort study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Atsuyuki Kawabata ◽  
Toshitaka Yoshii ◽  
Kenichiro Sakai ◽  
Takashi Hirai ◽  
Masato Yuasa ◽  
...  
Keyword(s):  
Cohort Study ◽  
Postoperative Complications ◽  
Spinal Deformity ◽  
Revision Surgery ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Adult Spinal Deformity ◽  
Non Union ◽  
Loss Of Correction

Abstract Background Parkinson’s disease (PD) has been found to increase the risk of postoperative complications in patients with adult spinal deformity (ASD). However, few studies have investigated this by directly comparing patients with PD and those without PD. Methods In this multicenter retrospective cohort study, we reviewed all surgically treated ASD patients with at least 2 years of follow-up. Among them, 27 had PD (PD+ group). Clinical data were collected on early and late postoperative complications as well as any revision surgery. Radiographic parameters were evaluated before and immediately after surgery and at final follow-up, including sagittal vertical axis (SVA), thoracic kyphosis, lumbar lordosis, sacral slope, and pelvic tilt. We compared the surgical outcomes and radiographic parameters of PD patients with those of non-PD patients. Results For early complications, the PD+ group demonstrated a higher rate of delirium than the PD− group. In terms of late complications, the rate of non-union was significantly higher in the PD+ group. Rates of rod failure and revision surgery due to mechanical complications also tended to be higher, but not significantly, in the PD+ group (p = 0.17, p = 0.13, respectively). SVA at final follow-up and loss of correction in SVA were significantly higher in the PD+ group. Conclusion Extra attention should be paid to perioperative complications, especially delirium, in PD patients undergoing surgery for ASD. Furthermore, loss of correction and rate of non-union were greater in these patients.

scholarly journals Treatment strategy for rod fractures following corrective fusion surgery in adult spinal deformity depends on symptoms and local alignment change

2018 ◽  
Vol 29 (1) ◽  
pp. 59-67 ◽  
Author(s):  
Yu Yamato ◽  
Tomohiko Hasegawa ◽  
Sho Kobayashi ◽  
Tatsuya Yasuda ◽  
Daisuke Togawa ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Revision Surgery ◽  
Treatment Strategy ◽  
Time Course ◽  
Clinical Symptoms ◽  
Adult Spinal Deformity ◽  
Nonoperative Treatment ◽  
Local Alignment ◽  
Fusion Surgery

OBJECTIVEDespite the significant incidence of rod fractures (RFs) following long-segment corrective fusion surgery, little is known about the optimal treatment strategy. The objectives of this study were to investigate the time course of clinical symptoms and treatments in patients with RFs following adult spinal deformity (ASD) surgery and to establish treatment recommendations.METHODSThis study was a retrospective case series of patients with RFs whose data were retrieved from a prospectively collected single-center database. The authors reviewed the cases of 304 patients (mean age 62.9 years) who underwent ASD surgery. Primary symptoms, time course of symptoms, and treatments were investigated by reviewing medical records. Standing whole-spine radiographs obtained before and after RF development and at last follow-up were evaluated. Osseous union was assessed using CT scans and intraoperative findings.RESULTSThere were 54 RFs in 53 patients (mean age 68.5 years [range 41–84 years]) occurring at a mean of 21 months (range 6–47 months) after surgery. In 1 patient RF occurred twice, with each case at a different time and level, and the symptoms and treatments for these 2 RFs were analyzed separately (1 case of revision surgery and 1 case of nonoperative treatment). The overall rate of RF observed on radiographs after a minimum follow-up of 1 year was 18.0% (54 of 300 cases). The clinical symptoms at the time of RF were pain in 77.8% (42 of 54 cases) and no onset of new symptoms in 20.5% (11 of 54 cases). The pain was temporary and had subsided in 19 of 42 cases (45%) within 2 weeks. In 36 of the 54 cases (66.7%) (including the first RF in the patient with 2 RFs), patients underwent revision surgery at a mean of 116 days (range 5–888 days) after diagnosis. In 18 cases patients received only nonoperative treatment as of the last follow-up, including 17 cases in which the patients experienced no pain and no remarkable progression of deformity (mean 18.5 months after RF development).CONCLUSIONSThis analysis of 54 RFs in 53 patients following corrective fusion surgery for ASD demonstrates a relationship between symptoms and alignment change. Revision surgeries were performed in a total of 36 cases. Nonoperative care was offered in 18 (33.3%) of 54 cases at the last follow-up, with no additional symptoms in 17 of the 18 cases. These data offer useful information regarding informed decision making for patients in whom an RF occurs after ASD surgery.

Predictors of Revision Surgery in Adult Spinal Deformity and Impact on Patient-Reported Outcomes and Satisfaction: Two-Year Follow-Up

2014 ◽  
Vol 14 (11) ◽  
pp. S21 ◽  
Author(s):  
Peter G. Passias ◽  
Sun Yang ◽  
Alexandra Soroceanu ◽  
Justin S. Smith ◽  
Christopher I. Shaffrey ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Revision Surgery ◽  
Patient Reported Outcomes ◽  
Adult Spinal Deformity ◽  
Patient Reported

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

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.

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

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.

Characteristics of spinopelvic alignment in Parkinson's disease: Comparison with adult spinal deformity

2017 ◽  
Vol 22 (1) ◽  
pp. 16-21 ◽  
Author(s):  
Kei Watanabe ◽  
Toru Hirano ◽  
Keiichi Katsumi ◽  
Masayuki Ohashi ◽  
Hirokazu Shoji ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Spinopelvic Alignment

scholarly journals Risk factors for revision surgery following primary adult spinal deformity surgery in patients 65 years and older

2016 ◽  
Vol 25 (4) ◽  
pp. 486-493 ◽  
Author(s):  
Varun Puvanesarajah ◽  
Francis H. Shen ◽  
Jourdan M. Cancienne ◽  
Wendy M. Novicoff ◽  
Amit Jain ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Elderly Patients ◽  
Spinal Deformity ◽  
Revision Surgery ◽  
Adult Spinal Deformity ◽  
Posterolateral Fusion ◽  
Smoking History ◽  
Revision Risk

OBJECTIVE Surgical correction of adult spinal deformity (ASD) is a complex undertaking with high revision rates. The elderly population is poorly studied with regard to revision surgery, yet senior citizens constitute a rapidly expanding surgical demographic. Previous studies aimed at elucidating appropriate risk factors for revision surgery have been limited by small cohort sizes. The purpose of this study was to assess factors that modify the risk of revision surgery in elderly patients with ASD. METHODS The PearlDiver database (2005–2012) was used to determine revision rates in elderly ASD patients treated with a primary thoracolumbar posterolateral fusion of 8 or more levels. Analyzed risk factors included demographics, comorbid conditions, and surgical factors. Significant univariate predictors were further analyzed with multivariate analysis. The causes of revision at each year of follow-up were determined. RESULTS A total of 2293 patients who had been treated with posterolateral fusion of 8 or more levels were identified. At the 1-year follow-up, 241 (10.5%) patients had been treated with revision surgery, while 424 (18.5%) had revision surgery within 5 years. On univariate analysis, obesity was found to be a significant predictor of revision surgery at 1 year, while bone morphogenetic protein (BMP) use was found to significantly decrease revision surgery at 4 and 5 years of followup. Diabetes mellitus, osteoporosis, and smoking history were all significant univariate predictors of increased revision risk at multiple years of follow-up. Multivariate analysis at 5 years of follow-up revealed that osteoporosis (OR 1.98, 95% CI 1.60–2.46, p < 0.0001) and BMP use (OR 0.70, 95% CI 0.56–0.88, p = 0.002) were significantly associated with an increased and decreased revision risk, respectively. Smoking history trended toward significance (OR 1.37, 95% CI 1.10–1.70, p = 0.005). Instrument failure was consistently the most commonly cited reason for revision. Five years following surgery, it was estimated that the cohort had 68.8% survivorship. CONCLUSIONS For elderly patients with ASD, osteoporosis increases the risk of revision surgery, while BMP use decreases the risk. Other comorbidities were not found to be significant predictors of long-term revision rates. It is expected that within 5 years following the index procedure, over 30% of patients will require revision surgery.

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