European Spine Journal

, Volume 27, Issue 9, pp 2272–2284 | Cite as

Complications in adult spine deformity surgery: a systematic review of the recent literature with reporting of aggregated incidences

  • Andrea Zanirato
  • Marco Damilano
  • Matteo Formica
  • Andrea Piazzolla
  • Alessio Lovi
  • Jorge Hugo Villafañe
  • Pedro Berjano



To review the incidence of perioperative and late complications of surgery for spinal deformity (ASD).


Review of the literature. We reviewed recent literature in English to investigate the incidence of complications in ASD surgery in the perioperative (≤ 3 months post-operative) and late (> 3 months post-operative) periods. Randomized-controlled trials, non-randomized trials, cohort studies, case–control studies, and case series published in 2005 or later were included. We divided articles according to surgical technique: open procedures (OP), minimally invasive surgery (MIS), and hybrid procedures (HP). Complications were recorded, grouped by surgical technique, and then classified according to a proposed Grading of Incidence of Complications (IOC).


Ninety-six publications reporting on 12,168 patients were included; 68 were level IV of evidence studies, 24 were level III, and 4 level II. Perioperative IOC was 26.5% in OP, 36.4% in HP, and 24.2% in MIS. Late IOC was 11.1% in OP, 15.4% in HP, and 14.0% in MIS. IOC was significantly higher for hybrid procedures compared to both open and MIS procedures.


Reported complications of surgery for ASD in the recent literature are frequent (24–36% perioperative plus 11–15% late). Open procedures were the most extensively reported in the literature. Complication rates are similar for OP and MIS. HP presented higher IOC likely due to the combination of OP and MIS respective complications. Small number of studies and heterogeneity in reporting could result in risk of bias in these results. Large-scale registry-based studies can fill this gap in the future.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.


Spine Deformity Scoliosis Adult spine deformity Registry Complications Systematic review Surgery Minimally invasive surgery Three-column osteotomy Pedicle subtraction osteotomy 


Compliance with ethical standards

Conflict of interest

The authors of the paper have not received specific funding to perform the research.

Supplementary material

586_2018_5535_MOESM1_ESM.pptx (180 kb)
Supplementary material 1 (PPTX 180 kb)
586_2018_5535_MOESM2_ESM.docx (216 kb)
Supplementary material 2 (DOCX 216 kb)


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Copyright information

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

Authors and Affiliations

  • Andrea Zanirato
    • 1
  • Marco Damilano
    • 2
  • Matteo Formica
    • 1
  • Andrea Piazzolla
    • 3
  • Alessio Lovi
    • 2
  • Jorge Hugo Villafañe
    • 4
  • Pedro Berjano
    • 2
  1. 1.Clinica OrtopedicaIRCCS AOU SAN MARTINO ISTGenoaItaly
  2. 2.IRCCS Istituto Ortopedico GaleazziMilanItaly
  3. 3.U.O.C. Ortopedia e Traumatologia UniversitariaAzienda Ospedaliero Universitaria Policlinico di BariBariItaly
  4. 4.IRCCS Fondazione Don Carlo GnocchiMilanItaly

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