Risk factors for medical complications after long-level internal fixation in the treatment of adult degenerative scoliosis
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This study evaluates baseline patient characteristics and surgical parameters for risk factors of medical complications in ASD patients received posterior long level internal fixation.
Analysis of consecutive patients who underwent posterior long-level instruction fixation for adult degenerative scoliosis (ADS) with a minimum of two year follow-up was performed. Pre-operative risk factors, intraoperative variables, peri-operative radiographic parameters, and surgical-related risk factors were collected to analyze the effect of risk factors on medical complications. Patients were separated into groups with and without medical complication. Then, complication group was further classified as major or minor medical complications. Potential risk factors were identified by univariate testing. Multivariate logistic regression was used to evaluate independent predictors of medical complications.
One hundred and thirty-one ADS patients who underwent posterior long segment pedicle screws fixation were included. Total medical complication incidence was 25.2%, which included infection (12.2%), neurological (11.5%), cardiopulmonary (7.6%), gastrointestinal (6.1%), and renal (1.5%) complications. Overall, 7.6% of patients developed major medical complications, and 17.6% of patients developed minor medical complications. The radiographic parameters of pre-operative and last follow-up had no significant difference between the groups of medical complications and the major or minor medical complications subgroups. However, the incidence of cerebrospinal fluid leak (CFL) in patients who without medical complications was much lower than that with medical complications (18.4 vs. 42.4%, P = 0.005). Independent risk factors for development of medical complications included smoking (OR = 6.45, P = 0.012), heart disease (OR = 10.07, P = 0.012), fusion level (OR = 2.12, P = 0.001), and length of hospital stay (LOS) (OR = 2.11, P = 0.000). Independent risk factors for development of major medical complications were diabetes (OR 6.81, P = 0.047) and heart disease (OR = 5.99, P = 0.049). Except for the last follow-up, Oswestry Disability Index and visual analog scale of the patient experienced medical complications trend higher score; the clinical outcomes have no significant difference between the medical and major complications groups.
Heart disease comorbidity is an independent risk factor for both medical and major medical complications. Smoking, fusion level, and LOS are independent risk factors for medical complication. Diabetes is the independent risk factors for major medical complications.
KeywordsAdult spinal deformity Medical complications Risk factors Posterior long-level spinal fusion
The author thank the invaluable support from Beijing Chaoyang Hospital affiliated to China Capital Medical University. The author thanks Dr. Yong Hai who supervised the study, provided technique support, and corrected some mistakes. The authors also thank Dr. Xiang-yao Sun and Xiang-long Meng for providing the analysis of the clinical data.
This study was supported partially by research fund provided by National Natural Science Foundation of China (NSFC) No. 81372008 and China Scholarship Council No. 201608110199.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no competing interests.
The study was in accordance with the ethical standards of the institutional research committee, the 1964 Helsinki declaration, and its later amendments. For this type of study formal consent is not required.
- 11.Hsieh M K, Chen L H, Niu C C, Fu T S, Lai P L, Chen W J (2015) Combined anterior lumbar interbody fusion and instrumented posterolateral fusion for degenerative lumbar scoliosis: indication and surgical outcomes. BMC Surg 15(15):26Google Scholar
- 16.Park P, Wang MY, Lafage V, Nguyen S, Ziewacz J, Okonkwo DO, Uribe JS, Eastlack RK, Anand N, Haque R, Fessler RG, Kanter AS, Deviren V, La Marca F, Smith JS, Shaffrey CI, Mundis GM Jr, Mummaneni PV, International Spine Study Group (2015) Comparison of two minimally invasive surgery strategies to treat adult spinal deformity. J Neurosurg Spine 22(4):374–380CrossRefGoogle Scholar
- 17.Crandall DG, Revella J (2009) Transforaminal lumbar interbody fusion versus anterior lumbar interbody fusion as an adjunct to posterior instrumented correction of degenerative lumbar scoliosis: three year clinical and radiographic outcomes. Spine (Phila Pa 1976) 34(20):2126–2133CrossRefGoogle Scholar
- 18.Zimmerman RM, Mohamed AS, Skolasky RL, Robinson MD, Kebaish KM (2010) Functional outcomes and complications after primary spinal surgery for scoliosis in adults aged forty years or older: a prospective study with minimum two-year follow-up. Spine (Phila Pa 1976) 35(20):1861–1866CrossRefGoogle Scholar
- 21.Soroceanu A, Burton DC, Oren JH, Smith JS, Hostin R, Shaffrey CI, Akbarnia BA, Ames CP, Errico TJ, Bess S, Gupta MC, Deviren V, Schwab FJ, Lafage V, International Spine Study Group (2016) Medical complications after adult spinal deformity surgery: incidence, risk factors, and clinical impact. Spine (Phila Pa 1976) 41(22):1718–1723CrossRefGoogle Scholar
- 22.Soroceanu A, Burton D C, Diebo B G, Smith J S, Hostin R, Shaffrey C I, Boachie-Adjei O, Mundis G M, Jr, Ames C, Errico T J, Bess S, Gupta M C, Hart R A, Schwab F J, Lafage V, International Spine Study Group (2015) Impact of obesity on complications, infection, and patient-reported outcomes in adult spinal deformity surgery. J Neurosurg Spine 1–9Google Scholar
- 27.Bianco K, Norton R, Schwab F, Smith JS, Klineberg E, Obeid I, Mundis G Jr, Shaffrey CI, Kebaish K, Hostin R, Hart R, Gupta MC, Burton D, Ames C, Boachie-Adjei O, Protopsaltis TS, Lafage V, International Spine Study G (2014) Complications and intercenter variability of three-column osteotomies for spinal deformity surgery: a retrospective review of 423 patients. Neurosurg Focus 36(5):E18CrossRefGoogle Scholar
- 28.Auerbach JD, Lenke LG, Bridwell KH, Sehn JK, Milby AH, Bumpass D, Crawford CH 3rd, O'Shaughnessy BA, Buchowski JM, Chang MS, Zebala LP, Sides BA (2012) Major complications and comparison between 3-column osteotomy techniques in 105 consecutive spinal deformity procedures. Spine (Phila Pa 1976) 37(14):1198–1210CrossRefGoogle Scholar
- 30.Yamato Y, Matsuyama Y, Hasegawa K, Aota Y, Akazawa T, Iida T, Ueyama K, Uno K, Kanemura T, Kawakami N, Kotani T, Takaso M, Takahashi J, Tanaka M, Taneichi H, Tsuji T, Hosoe H, Mochida J, Shimizu T, Yonezawa I, Watanabe K, Matsumoto M, Committee for Adult Deformity J S S (2017) A Japanese nationwide multicenter survey on perioperative complications of corrective fusion for elderly patients with adult spinal deformity. J Orthop Sci 22(2):237–242CrossRefGoogle Scholar
- 38.Blamoutier A, Guigui P, Charosky S, Roussouly P, Chopin D, Groupe d'Etude de la S (2012) Surgery of lumbar and thoracolumbar scolioses in adults over 50. Morbidity and survival in a multicenter retrospective cohort of 180 patients with a mean follow-up of 4.5 years. Orthop Traumatol Surg Res 98(5):528–535CrossRefGoogle Scholar
- 39.Kim HJ, Iyer S, Zebala LP, Kelly MP, Sciubba D, Protopsaltis TS, Gupta M, Neuman BJ, Mundis GM, Ames CP, Smith JS, Hart R, Burton D, Klineberg EO, International Spine Study G (2017) Perioperative neurologic complications in adult spinal deformity surgery: incidence and risk factors in 564 patients. Spine (Phila Pa 1976) 42(6):420–427CrossRefGoogle Scholar
- 40.Sciubba DM, Yurter A, Smith JS, Kelly MP, Scheer JK, Goodwin CR, Lafage V, Hart RA, Bess S, Kebaish K, Schwab F, Shaffrey CI, Ames CP, International Spine Study G (2015) A comprehensive review of complication rates after surgery for adult deformity: a reference for informed consent. Spine Deform 3(6):575–594CrossRefGoogle Scholar
- 41.Schwab FJ, Hawkinson N, Lafage V, Smith JS, Hart R, Mundis G, Burton DC, Line B, Akbarnia B, Boachie-Adjei O, Hostin R, Shaffrey CI, Arlet V, Wood K, Gupta M, Bess S, Mummaneni PV, International Spine Study G (2012) Risk factors for major peri-operative complications in adult spinal deformity surgery: a multi-center review of 953 consecutive patients. Eur Spine J 21(12):2603–2610CrossRefGoogle Scholar