Perioperative Predictive Factors for Positive Outcomes in Spine Fusion for Adult Deformity Correction

Purpose: Identifying perioperative factors that may influence the outcomes of long spine fusion for the treatment of adult deformity is key for tailored surgical planning and targeted informed consent. The aim of this study was to analyze the association between demographic or perioperative factors and clinical outcomes 2 years after long spine fusion for the treatment of adult deformity. Methods: This study is a multivariate analysis of retrospectively collected data. All patients who underwent long fusion of the lumbar spine for adult spinal deformity (January 2016–June 2019) were included. The outcomes of interest were the Oswestry disability index (ODI), visual analogic scale (VAS) preoperatively and at 1 and 2 years’ follow up, age, body mass index, American Society of Anaesthesiologists (ASA) score, upper and lowest instrumented vertebrae (UIV and LIV, respectively), length of surgery, estimated blood loss, and length of hospital stay. Results: Data from 192 patients were available. The ODI at 2 years correlated weakly to moderately with age (r = 0.4), BMI (r = 0.2), ASA (r = 0.3), and LIV (r = 0.2), and strongly with preoperative ODI (r = 0.6). The leg VAS at 2 years moderately correlated with age (r = 0.3) and BMI (r = 0.3). Conclusion: ODI and VAS at 2 years’ follow-up had no to little association to preoperative age, health status, LIV, or other peroperative data, but showed a strong correlation with preoperative ODI and pain level.

Surgical Outcomes and Fusion Rate Following Spine Fusion Surgeries in Patients with Chronic Kidney Disease: According to Kidney Function

PURPOSE. To evaluate the surgical outcomes and fusion rate following lumbar fusion surgeries in patients with chronic kidney disease (CKD) according to kidney function.METHODS. From March 2017 to February 2021, 54 consecutive adult patients with CKD who underwent spine fusion surgery were enrolled. According to the glomerular filtration rate (GFR) categories, 35 patients were classified into the non-end-stage renal disease (ESRD) group (GFR categories 3a–4, eGFR 15–59 mL/min/1.73 m2) and 19 patients into the ESRD group (GFR category 5, eGFR <15 mL/min/1.73 m2).RESULTS. Baseline characteristics did not differ between the groups. The mean number of fused vertebrae (4.9 ± 2.3 vs. 4.1 ± 2.0, p = 0.122), operative time (228.4 ± 129.6 min vs. 160.5 ± 87.5 min, p = 0.113), and surgical bleeding (743.1 ± 630.5 mL vs. 539.5 ± 384.4 mL, p = 0.354) did not differ between the groups. The rates of medical complications (25.7% vs. 52.6%, p = 0.048) and 3-month readmission (8.6% vs. 35.3%, p = 0.045) were significantly different between the groups. The 3-month mortality tended to be higher in the ESRD group (10.5%) than which in the non-ESRD group (2.9%), but the difference was not statistically significant (p = 0.280). The rate of pseudarthrosis was significantly higher in the ESRD group (35.3%) than in the non-ESRD group (9.1%, p = 0.047).CONCLUSIONS. Surgeons should be aware of the high morbidity and the pseudarthrosis when considering spine surgeries in patients with ESRD.