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

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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Different types of mechanical complications after surgical correction of adult spine deformity with osteotomy

World Journal of Meta-Analysis ◽

10.13105/wjma.v5.i6.132 ◽

2017 ◽

Vol 5 (6) ◽

pp. 132-149 ◽

Cited By ~ 4

Author(s):

Cameron Barton ◽

Andriy Noshchenko ◽

Vikas V Patel ◽

Christopher M J Cain ◽

Christopher Kleck ◽

...

Keyword(s):

Surgical Correction ◽

Spine Deformity ◽

Mechanical Complications ◽

Adult Spine Deformity ◽

Different Types ◽

Adult Spine

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Complications and Risk Factors of Surgery for Adult Spine Deformity

The Journal of the Korean Orthopaedic Association ◽

10.4055/jkoa.2016.51.1.40 ◽

2016 ◽

Vol 51 (1) ◽

pp. 40

Author(s):

Whoan Jeang Kim ◽

Yong Han Cha

Keyword(s):

Risk Factors ◽

Spine Deformity ◽

Adult Spine Deformity ◽

Adult Spine

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Evaluation of the Fluctuation of Health-Related Quality of Life Scores and Radiographic Sagittal Parameters for Follow-Up in Adult Spine Deformity Patients

The Spine Journal ◽

10.1016/j.spinee.2016.07.459 ◽

2016 ◽

Vol 16 (10) ◽

pp. S350-S351

Author(s):

Ibrahim Obeid ◽

Francisco J. Perez-Grueso ◽

Vincent Challier ◽

Louis Boissiere ◽

Ahmet Alanay ◽

...

Keyword(s):

Quality Of Life ◽

Spine Deformity ◽

Health Related Quality ◽

Adult Spine Deformity ◽

Related Quality ◽

Health Related ◽

Sagittal Parameters ◽

Adult Spine

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

European Spine Journal ◽

10.1007/s00586-019-06253-1 ◽

2019 ◽

Vol 29 (4) ◽

pp. 904-913 ◽

Cited By ~ 9

Author(s):

Amer Sebaaly ◽

Martin Gehrchen ◽

Clément Silvestre ◽

Khalil Kharrat ◽

Tanvir Johanning Bari ◽

...

Keyword(s):

Complication Rate ◽

Adult Spinal Deformity ◽

Spine Deformity ◽

Mechanical Complication ◽

Level Of Evidence ◽

Multicentric Study ◽

Mechanical Complications ◽

Roussouly Classification ◽

Normal Shape

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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Vertebral subluxation during three-column osteotomy in surgical correction of adult spine deformity: incidence, risk factors, and complications

European Spine Journal ◽

10.1007/s00586-017-5285-2 ◽

2017 ◽

Vol 27 (3) ◽

pp. 630-635 ◽

Cited By ~ 2

Author(s):

Jun Qiao ◽

Lingyan Xiao ◽

Xu Sun ◽

Benlong Shi ◽

Zhen Liu ◽

...

Keyword(s):

Risk Factors ◽

Surgical Correction ◽

Spine Deformity ◽

Adult Spine Deformity ◽

Incidence Risk ◽

Vertebral Subluxation ◽

Adult Spine

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Diversity in Surgical Decision Strategies for Adult Spine Deformity Treatment: The Effects of Neurosurgery or Orthopedic Training Background and Surgical Experience

Neurospine ◽

10.14245/ns.1836086.043 ◽

2018 ◽

Vol 15 (4) ◽

pp. 353-361 ◽

Cited By ~ 4

Author(s):

Jiin Kang ◽

Naobumi Hosogane ◽

Christopher Ames ◽

Frank Schwab ◽

Robert Hart ◽

...

Keyword(s):

Spine Deformity ◽

Surgical Experience ◽

Decision Strategies ◽

Surgical Decision ◽

Adult Spine Deformity ◽

Adult Spine ◽

Training Background

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Determinants of Poor Glycemic Control in Patients with Kidney Transplants: A Single-Center Retrospective Cohort Study in Canada

Canadian Journal of Kidney Health and Disease ◽

10.1177/2054358120922628 ◽

2020 ◽

Vol 7 ◽

pp. 205435812092262

Author(s):

Daniel Chan Chun Kong ◽

Ayub Akbari ◽

Janine Malcolm ◽

Mary-Anne Doyle ◽

Stephanie Hoar

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Peritoneal Dialysis ◽

Glycemic Control ◽

Kidney Transplant ◽

Deceased Donor ◽

Poor Glycemic Control ◽

Single Center ◽

Readmission Rates

Background: Kidney transplant immunosuppressive medications are known to impair glucose metabolism, causing worsened glycemic control in patients with pre-transplant diabetes mellitus (PrTDM) and new onset of diabetes after transplant (NODAT). Objectives: To determine the incidence, risk factors, and outcomes of both PrTDM and NODAT patients. Design: This is a single-center retrospective observational cohort study. Setting: The Ottawa Hospital, Ontario, Canada. Participant: A total of 132 adult (>18 years) kidney transplant patients from 2013 to 2015 were retrospectively followed 3 years post-transplant. Measurements: Patient characteristics, transplant information, pre- and post-transplant HbA1C and random glucose, follow-up appointments, complications, and readmissions. Methods: We looked at the prevalence of poor glycemic control (HbA1c >8.5%) in the PrTDM group before and after transplant and compared the prevalence, follow-up appointments, and rate of complications and readmission rates in both the PrTDM and NODAT groups. We determined the risk factors of developing poor glycemic control in PrTDM patients and NODAT. Student t-test was used to compare means, chi-squared test was used to compare percentages, and univariate analysis to determine risk factors was performed by logistical regression. Results: A total of 42 patients (31.8%) had PrTDM and 12 patients (13.3%) developed NODAT. Poor glycemic control (HbA1c >8.5%) was more prevalent in the PrTDM (76.4%) patients compared to those with NODAT (16.7%; P < .01). PrTDM patients were more likely to receive follow-up with an endocrinologist ( P < .01) and diabetes nurse ( P < .01) compared to those with NODAT. There were no differences in the complication and readmission rates for PrTDM and NODAT patients. Receiving a transplant from a deceased donor was associated with having poor glycemic control, odds ratio (OR) = 3.34, confidence interval (CI = 1.08, 10.4), P = .04. Both patient age, OR = 1.07, CI (1.02, 1.3), P < .01, and peritoneal dialysis prior to transplant, OR = 4.57, CI (1.28, 16.3), P = .02, were associated with NODAT. Limitations: Our study was limited by our small sample size. We also could not account for any diabetes screening performed outside of our center or follow-up appointments with family physicians or community endocrinologists. Conclusion: Poor glycemic control is common in the kidney transplant population. Glycemic targets for patients with PrTDM are not being met in our center and our study highlights the gap in the literature focusing on the prevalence and outcomes of poor glycemic control in these patients. Closer follow-up and attention may be needed for those who are at risk for worse glycemic control, which include older patients, those who received a deceased donor kidney, and/or prior peritoneal dialysis.

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