Long-term Morbidity in Patients Following Surgical Correction of Adult Spinal Deformity: Results from a Cohort with Minimum 5 Year Follow-up.

Abstract

Retrospective. To describe the rate of post-operative morbidity before and after 2-year follow-up for patients undergoing surgical correction of adult spinal deformity. Advances in modern surgical techniques for deformity surgery have shown promising short-term clinical results. However, the permanence of radiographic correction, mechanical complications, and revision surgery in adult spinal deformity (ASD) surgery remains a clinical challenge. Little information exists on the incidence of long-term morbidity beyond the acute post-operative window. ASD patients with complete baseline (BL) and 5-year (5Y) health related quality of life (HRQL) and radiographic data were included. Rates of adverse events, including proximal junctional kyphosis (PJK), proximal junctional failure (PJF), and reoperations up to 5Y were documented. Primary and revision surgeries were compared. We used logistic regression analysis to adjust for demographic and surgical confounders. Of 118 patients eligible for 5Y follow up, 99(83.9%) had complete follow-up data. The majority were female (83%), mean age 54.1 yrs and 10.4 levels fused and 14 undergoing 3-CO. 33 patients had a prior fusion and 66 were primary cases. By 5Y postop the cohort had a adverse event rate of 70.7% with 25(25.3%) sustaining a major complication and 26(26.3%) receiving reoperation. 38 (38.4%) developed PJK by 5Y and 3 (4.0%) developed PJF. The cohort had a significantly higher rate of complications (63.6% vs. 19.2%), PJK (34.3% vs. 4.0%), and reoperations (21.2% vs. 5.1%) before 2Y, all P<0.01. The most common complications beyond 2Y were mechanical complications. While incidence of adverse events was high before two years, there was a substantial reduction in longer follow-up indicating complications after two years are less common. Complications beyond two years consisted mostly of mechanical issues.