Non-neurologic adverse events after complex adult spinal deformity surgery: results from the prospective, multicenter Scoli-RISK-1 study

Kenny Yat Hong Kwan,Michael G Fehlings,Frank J Schwab,Kenneth Man Chee Cheung,Christopher I Shaffrey,Yong Qiu,Dino Samartzis,Leah Y Carreon,Christopher P Ames,Cora Bow,Mark B Dekutoski,Benny T Dahl,Stephen J Lewis,Yukihiro Matsuyama,Khaled M Kebaish,Oheneba Boachie-Adjei,Ferran Pellisé,Lawrence G Lenke,Hossein Mehdian

doi:10.1007/s00586-018-5790-y

Abstract

PurposeAccurate information regarding the expected complications of complex adult spinal deformity (ASD) is important for shared decision making and informed consent. The purpose of the present study was to investigate the rate and types of non-neurologic adverse events after complex ASD surgeries, and to identify risk factors that affect their occurrence.MethodsThe details and occurrence of all non-neurologic adverse events were reviewed in a prospective cohort of 272 patients after complex ASD surgical correction in a mulitcentre database of the Scoli-RISK-1 study with a planned follow-up of 2 years. Logistic regression analyses were used to identify potential risk factors for non-neurologic adverse events.ResultsOf the 272 patients, 184 experienced a total of 515 non-neurologic adverse events for an incidence of 67.6%. 121 (44.5%) patients suffered from more than one adverse event. The most frequent non-neurologic adverse events were surgically related (27.6%), of which implant failure and dural tear were most common. In the unadjusted analyses, significant factors for non-neurologic adverse events were age, previous spine surgery performed, number of documented non-neurologic comorbidities and ASA grade. On multivariable logistic regression analysis, previous spine surgery was the only independent risk factor for non-neurologic adverse events.ConclusionsThe incidence of non-neurologic adverse events for patients undergoing corrective surgeries for ASD was 67.6%. Previous spinal surgery was the only independent risk factor predicting the occurrence of non-neurologic adverse events. These findings complement the earlier report of neurologic complications after ASD surgeries from the Scoli-RISK-1 study.Graphical abstractThese slides can be retrieved under Electronic Supplementary Material.

Highlights

Materials and methodsSurgery for adult spinal deformity (ASD) has increased in magnitude and complexity, and often deformities require three-column osteotomies (3COs) such as pedicle substraction osteotomy (PSO) or vertebral column resection (VCR) [1,2,3,4,5,6,7]
While operative management is known to be associated with greater quality-adjusted life years than non-operative treatment [8], complication rates of up to 50% have been reported in this patient population [1, 2, 7, 9,10,11,12,13,14,15]
Knowledge of the true incidence, types and risk factors for non-neurologic adverse events after ASD surgeries is integral for a complete risk profile assessment, preoperative counseling process and establishing future preventative measures

Summary

Introduction

Materials and methodsSurgery for adult spinal deformity (ASD) has increased in magnitude and complexity, and often deformities require three-column osteotomies (3COs) such as pedicle substraction osteotomy (PSO) or vertebral column resection (VCR) [1,2,3,4,5,6,7]. The postoperative neurologic data have been reported [16], which showed a new neurologic deficit rate of more than 20% after complex ASD surgeries. This is much higher than the previously reported rates which ranged from 1 to 10% [1, 4, 9,10,11, 17,18,19,20,21] and has been attributed to the prospective nature of this study with rigorous assessment and documentation required from each participating site. Knowledge of the true incidence, types and risk factors for non-neurologic adverse events after ASD surgeries is integral for a complete risk profile assessment, preoperative counseling process and establishing future preventative measures

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