European Spine Journal

, Volume 28, Issue 1, pp 180–187 | Cite as

Predictive model for major complications 2 years after corrective spine surgery for adult spinal deformity

  • Mitsuru Yagi
  • Naobumi Hosogane
  • Nobuyuki Fujita
  • Eijiro Okada
  • Osahiko Tsuji
  • Narihito Nagoshi
  • Takashi Asazuma
  • Takashi Tsuji
  • Masaya Nakamura
  • Morio Matsumoto
  • Kota WatanabeEmail author
Original Article



ASD surgery improves a patient’s health-related quality of life, but it has a high complication rate. The aim of this study was to create a predictive model for complications after surgical treatment for adult spinal deformity (ASD), using spinal alignment, demographic data, and surgical invasiveness.


This study included 195 surgically treated ASD patients who were > 50 years old and had 2-year follow-up from multicenter database. Variables which included age, gender, BMI, BMD, frailty, fusion level, UIV and LIV, primary or revision surgery, pedicle subtraction osteotomy, spinal alignment, Schwab-SRS type, surgical time, and blood loss were recorded and analyzed at least 2 years after surgery. Decision-making trees for 2-year postoperative complications were constructed and validated by a 7:3 data split for training and testing. External validation was performed for 25 ASD patients who had surgery at a different hospital.


Complications developed in 48% of the training samples. Almost half of the complications developed in late post-op period, and implant-related complications were the most common complication at 2 years after surgery. Univariate analyses showed that BMD, frailty, PSO, LIV, PI-LL, and EBL were risk factors for complications. Multivariate analysis showed that low BMD, PI-LL > 30°, and frailty were independent risk factors for complications. In the testing samples, our predictive model was 92% accurate with an area under the receiver operating characteristic curve of 0.963 and 84% accurate in the external validation.


A successful model was developed for predicting surgical complications. Our model could inform physicians about the risk of complications in ASD patients in the 2-year postoperative period.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.


Adult spinal deformity Complication Surgery Risk stratification Predictive model 



This study was approved by the appropriate institutional review board.

Compliance with ethical standards

Conflict of interest

The authors report no conflict of interest.

Supplementary material

586_2018_5816_MOESM1_ESM.pptx (21 mb)
Supplementary material 1 (PPTX 21467 kb)
586_2018_5816_MOESM2_ESM.pptx (147 kb)
Supplementary material 2 (PPTX 146 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Mitsuru Yagi
    • 1
    • 2
    • 3
  • Naobumi Hosogane
    • 3
    • 4
  • Nobuyuki Fujita
    • 1
    • 3
  • Eijiro Okada
    • 1
    • 3
  • Osahiko Tsuji
    • 1
    • 3
  • Narihito Nagoshi
    • 1
    • 3
  • Takashi Asazuma
    • 2
  • Takashi Tsuji
    • 3
    • 5
  • Masaya Nakamura
    • 1
    • 3
  • Morio Matsumoto
    • 1
    • 3
  • Kota Watanabe
    • 1
    • 3
    Email author
  1. 1.Department of Orthopedic SurgeryKeio University School of MedicineTokyoJapan
  2. 2.Department of Orthopedic SurgeryNational Hospital Organization Murayama Medical CenterTokyoJapan
  3. 3.Keio Spine Research GroupTokyoJapan
  4. 4.Department of Orthopedic SurgeryNational Defense Medical CollegeTokorozawaJapan
  5. 5.Department of Orthopedic SurgeryFujita Health UniversityToyoakeJapan

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