4:10 Complications of spinal fusion in treatment of adult spinal deformity

Abstract

Purpose of study: Surgical treatment for adult spinal deformity from 1992 to 2000 with a minimum of 1-year follow-up. To describe the overall complications in 363 adult spinal deformity patients who underwent 410 spinal fusion operations.Methods used: Included were 62 men and 301 women, average age 48 years (range, 20 to 86). There were 101 patients aged 20 to 40 years, 161 patients aged 41 to 60 years and 101 patients older than 60 years. Procedures included 278 deformities and 132 deformities with pseudarthrosis. There were 24 anterior, 156 posterior, 161 same-day anterior/posterior and 69 staged anterior/posterior approaches.of findings: The major complications rate was 29%. The overall major/minor complications rate was 58%. The major complications included 11 pulmonary emboli, 6 lower limbs paraparesis, 5 leg weakness with muscle strength 1 to 3/5, 2 cauda equina syndromes, 2 epidural hematoma requiring emergency decompression, 5 major vessel injury, 3 bowel necrosis, 1 bowel perforation, 2 SIADH, 2 ARDS, 24 respiratory compromise, 6 sepsis, 12 deep wound infection, 5 deep vein thrombosis and 2 ureteral injuries. Minor complications included 4 hook pull-outs, 3 pedicle screw pull-outs, 11 dural tears, 6 spinal headache, 1 acute hearing loss, 7 nerve root entrapment, 8 lower limb weakness with muscle strength 4/5, 14 pleural effusions, 25 postoperative ileus, 4 Clostridium difficile–positive diarrhea, 18 urinary tract infections, 17 urinary retention, 6 superficial wound infections, 3 transfusion reactions and 27 altered mental status. There were 9 deaths, 3 from pulmonary embolism, 1 intra-abdominal bleeding, 1 sepsis, 1 coagulopathy, 1 brain herniation, 1 bowel necrosis and multiple organ failure and 1 intraoperative death resulting from cardiac ischemia. Tracheostomy was performed for 8 patients. Instrumentation removal in 26 patients. The pseudarthrosis rate was 6%. In the 132 patients for pseudarthrosis repair, 10 continued to have pseudarthrosis. The fusion rate for pseudarthrosis repair was 92% (Table 1)Table 1Fusion rate for pseudarthrosis repairAge (years)Total complicationMajor complicationMinor complication20–4047%20%34%40–6058%31%44%>6067%32%55%All procedures58%29%45%.Relationship between findings and existing knowledge: The study contributes to the literature by reporting on the largest series of patients with adult reconstructive deformity surgery complications.Overall significance of findings: Major complications in adult reconstructive deformity surgery are significant and age related but with knowledge can be decreased.Disclosures: No disclosures.Conflict of interest: No conflicts.