The Implications of Limited Decompression and Fusion or Decompression Alone Compared to Full Correction in Adult Deformity Surgery

Abstract

Introduction Some patients request limited surgery instead of full deformity correction and stabilization because of the perceived lower morbidity, risk, and magnitude of surgery. This study is an attempt to evaluate outcomes in patient who select limited fusion/decompression compared with patients who elect to undergo complete deformity correction/stabilization. Materials and Methods We performed a retrospective review of consecutive adult spinal deformity patients treated over a 6 year period who had minimum 1 year of follow-up in the practice of a single spinal surgeon. Patients with cervical or pathological deformity were excluded. Some patients chose only to undergo partial corrections or decompression alone. We compared demographic data of patients choosing among these three options and additionally compared intraoperative blood loss, length of surgery, and length of stay. We also examined the early and late complication rate as well as the number of subsequent spinal surgeries. We additionally compared perioperative change in quality of life measures (ODI, VAS, and SF36v2). Results A total of 103 patients were identified, out of which 59 patients underwent full correction while 24 underwent partial correction and 20 underwent decompression alone. Full correction was achieved in 54 of the 59 patients (91.5%). Patients choosing full correction were significantly younger than those undergoing less than full correction ( p < 0.0001). Attempted full correction was associated with significantly longer length of stay ( p = 0.016), longer surgical duration ( p < 0.0001), and greater volume of intraoperative blood loss ( p = 0.002). There was no clear relationship between extent of surgery and rate of early complications. Late complication and reoperation rates increased as the extent of the initial surgery increased however these differences were not significant. Only 26.2% of patients provided quality of life data. Those undergoing full correction had greatest improvement in ODI, VAS, SF36v2 physical and mental scores, particularly when full correction was achieved. No statistical differences in quality of life measures were detected although type II error is probable. Conclusion Although full deformity correction is more resource intensive and associated with a higher reoperative rate, our results suggest that achieving full deformity correction may achieve the greatest improvement in quality of life measures. A low response rate on quality of life measure surveys limits the strength of our conclusions.