Spine Surgeon NYU School of Medicine New Canaan, CT, US
Introduction: Adult spinal deformity(ASD) corrective surgery is often a highly invasive procedure portending patients to immediate and long-term complications. The purpose of this study is to compare rates of certain complications by and after two years following ASD surgery.
Methods: ASD patients with minimum 3-year and up to 5-year data were included. Complication groups were defined as: 1) any complication,2) major,3) medical,4) mechanical,5) radiographic, and 6) reoperation. Complications were stratified by occurrence Before or After two years(2Y) postoperatively. Multivariable logistic regression adjusting for age and invasiveness determined likelihood of the occurrence for certain complications for those suffering a major complication or undergoing reoperation Before or After 2Y.
Results: 481 patients included(age:59±15 years,77% female,CCI: 1.7±1.7). Before 2Y, complication rates: 74% ≥1 complication,19% major,17% medical,13% neurological,46% radiographic,15% mechanical,20% required reoperation. After 2Y, complication rates: 19% ≥1 complication,3% major,1% neurological,17% radiographic,3% mechanical,1.5% required reoperation. Radiographic and mechanical complications had the highest proportions After 2Y at 23% and 18%, respectively. This translated to 75% of all complications occurring After 2Y to be mechanical- or radiographic-related. The cause of major complication After 2Y was more likely mechanical(OR: 148,[37-598];p < .001), in addition to the indication for reoperation After 2Y(OR: 51,[10-255];p < .001). Patients suffering a radiographic complication After 2Y were less likely to have suffered a radiographic complication Before 2Y(OR: 5,p < .001). Patients suffering a major complication or reoperation Before 2Y were not more likely to develop any certain complication After 2Y(all p>.05). Patients developing a major complication After 2Y had higher rates of each complication Before 2Y(all p < .05), but those undergoing reoperation After 2Y were only predicted by PJF(OR: 6,[1.1-37.1]) Before 2Y.
Conclusion : Mechanical and radiographic complications occur three times more often than other complications after two years following deformity correction. This study increases our understanding of complications occurring later in the postoperative course to aid the deformity surgeon during monitoring and management.
