Advertisement

European Spine Journal

, Volume 28, Issue 1, pp 155–160 | Cite as

Revision adult spinal deformity surgery: Does the number of previous operations have a negative impact on outcome?

  • Xiaobang Hu
  • Isador H. LiebermanEmail author
Original Article

Abstract

Purpose

To study the effect of the number of previous operations on the outcome of revision adult spinal deformity (ASD) surgery.

Methods

One hundred and thirty-seven consecutive patients who underwent revision ASD surgery were classified as follows: those who had one previous operation (group 1), had two previous operations (group 2) and had three or more previous operations (group 3). Perioperative complications and additional surgeries were reviewed. Back pain, leg pain, ODI scores and radiographic measurements were obtained.

Results

Preoperatively, the patients in group 3 had worse ODI (60.0 vs. 48.1 and 47.9, p < 0.01) but not back pain or leg pain. Group 2 and group 3 had worse coronal plumb line (38.4 and 35.8 mm vs. 18.2 mm, p < 0.05) and SVA (99.7 and 153.9 mm vs. 67.8 mm, p < 0.05). Group 3 had worse PI–LL mismatch (40.1° vs. 25.3° and 26.2°, p = 0.08). Minor and major perioperative complication rates were 27.5% in group 1, 31.1% in group 2 and 39.0% in group 3 (p > 0.05). At mean 30-month follow-up, the additional surgery rates were 7.8, 17.8 and 22.0%, respectively (p = 0.07). The patients in all groups had improved back pain, leg pain and ODI scores. The net improvements on back pain, leg pain and ODI were not statistically different between the groups.

Conclusions

Revision ASD patients who had two or more previous operations present with more coronal and sagittal imbalance and worse functional status. Patients who had three or more previous operations have relatively higher reoperation rate but similar perioperative complication rate and similar clinic improvements.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

Keywords

Adult spinal deformity Revision surgery Outcome 

Notes

Compliance with ethical standards

Conflicts of interest

The authors declare that there is no direct conflict of interest associated with this manuscript.

Supplementary material

586_2018_5747_MOESM1_ESM.pptx (277 kb)
Supplementary material 1 (PPTX 277 kb)

References

  1. 1.
    Cho SK, Bridwell KH, Lenke LG, Cho W, Zebala LP, Pahys JM, Kang MM, Yi JS, Baldus CR (2012) Comparative analysis of clinical outcome and complications in primary versus revision adult scoliosis surgery. Spine (Phila Pa 1976) 37:393–401.  https://doi.org/10.1097/brs.0b013e31821f0126 CrossRefGoogle Scholar
  2. 2.
    Smith JS, Klineberg E, Lafage V, Shaffrey CI, Schwab F, Lafage R, Hostin R, Mundis GM, Jr., Errico TJ, Kim HJ, Protopsaltis TS, Hamilton DK, Scheer JK, Soroceanu A, Kelly MP, Line B, Gupta M, Deviren V, Hart R, Burton DC, Bess S, Ames CP, International Spine Study G (2016) Prospective multicenter assessment of perioperative and minimum 2-year postoperative complication rates associated with adult spinal deformity surgery. J Neurosurg Spine 25:1–14.  https://doi.org/10.3171/2015.11.SPINE151036 Google Scholar
  3. 3.
    Uribe JS, Deukmedjian AR, Mummaneni PV, Fu KM, Mundis GM, Jr., Okonkwo DO, Kanter AS, Eastlack R, Wang MY, Anand N, Fessler RG, La Marca F, Park P, Lafage V, Deviren V, Bess S, Shaffrey CI, International Spine Study G (2014) Complications in adult spinal deformity surgery: an analysis of minimally invasive, hybrid, and open surgical techniques. Neurosurg Focus 36:E15.  https://doi.org/10.3171/2014.3.FOCUS13534 Google Scholar
  4. 4.
    Mok JM, Cloyd JM, Bradford DS, Hu SS, Deviren V, Smith JA, Tay B, Berven SH (2009) Reoperation after primary fusion for adult spinal deformity: rate, reason, and timing. Spine (Phila Pa 1976) 34:832–839.  https://doi.org/10.1097/brs.0b013e31819f2080 CrossRefGoogle Scholar
  5. 5.
    Pichelmann MA, Lenke LG, Bridwell KH, Good CR, O’Leary PT, Sides BA (2010) Revision rates following primary adult spinal deformity surgery: six hundred forty-three consecutive patients followed-up to twenty-two years postoperative. Spine (Phila Pa 1976) 35:219–226.  https://doi.org/10.1097/brs.0b013e3181c91180 CrossRefGoogle Scholar
  6. 6.
    Zhu F, Bao H, Liu Z, Bentley M, Zhu Z, Ding Y, Qiu Y (2014) Unanticipated revision surgery in adult spinal deformity: an experience with 815 cases at one institution. Spine (Phila Pa 1976) 39:B36–44.  https://doi.org/10.1097/brs.0000000000000463 CrossRefGoogle Scholar
  7. 7.
    Kelly MP, Lenke LG, Bridwell KH, Agarwal R, Godzik J, Koester L (2013) Fate of the adult revision spinal deformity patient: a single institution experience. Spine (Phila Pa 1976) 38:E1196–1200.  https://doi.org/10.1097/brs.0b013e31829e764b CrossRefGoogle Scholar
  8. 8.
    Puvanesarajah V, Shen FH, Cancienne JM, Novicoff WM, Jain A, Shimer AL, Hassanzadeh H (2016) Risk factors for revision surgery following primary adult spinal deformity surgery in patients 65 years and older. J Neurosurg Spine 25:486–493.  https://doi.org/10.3171/2016.2.SPINE151345 CrossRefGoogle Scholar
  9. 9.
    Fu L, Chang MS, Crandall DG, Revella J (2014) Comparative analysis of clinical outcomes and complications in patients with degenerative scoliosis undergoing primary versus revision surgery. Spine (Phila Pa 1976) 39:805–811.  https://doi.org/10.1097/brs.0000000000000283 CrossRefGoogle Scholar
  10. 10.
    Diebo BG, Passias PG, Marascalchi BJ, Jalai CM, Worley NJ, Errico TJ, Lafage V (2015) Primary Versus Revision Surgery in the Setting of Adult Spinal Deformity: A Nationwide Study on 10,912 Patients. Spine (Phila Pa 1976) 40:1674–1680.  https://doi.org/10.1097/brs.0000000000001114 CrossRefGoogle Scholar
  11. 11.
    Lafage V, Schwab F, Vira S, Hart R, Burton D, Smith JS, Boachie-Adjei O, Shelokov A, Hostin R, Shaffrey CI, Gupta M, Akbarnia BA, Bess S, Farcy JP (2011) Does vertebral level of pedicle subtraction osteotomy correlate with degree of spinopelvic parameter correction? J Neurosurg Spine 14:184–191CrossRefGoogle Scholar
  12. 12.
    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 3:575–594.  https://doi.org/10.1016/j.jspd.2015.04.005 CrossRefGoogle Scholar
  13. 13.
    Glassman SD, Hamill CL, Bridwell KH, Schwab FJ, Dimar JR, Lowe TG (2007) The impact of perioperative complications on clinical outcome in adult deformity surgery. Spine (Phila Pa 1976) 32:2764–2770.  https://doi.org/10.1097/brs.0b013e31815a7644 CrossRefGoogle Scholar
  14. 14.
    Yilgor C, Sogunmez N, Boissiere L, Yavuz Y, Obeid I, Kleinstuck F, Perez-Grueso FJS, Acaroglu E, Haddad S, Mannion AF, Pellise F, Alanay A, European Spine Study G (2017) Global Alignment and Proportion (GAP) Score: Development and Validation of a New Method of Analyzing Spinopelvic Alignment to Predict Mechanical Complications After Adult Spinal Deformity Surgery. J Bone Joint Surg Am 99:1661–1672.  https://doi.org/10.2106/JBJS.16.01594 CrossRefGoogle Scholar
  15. 15.
    Koller H, Pfanz C, Meier O, Hitzl W, Mayer M, Bullmann V, Schulte TL (2016) Factors influencing radiographic and clinical outcomes in adult scoliosis surgery: a study of 448 European patients. Eur Spine J 25:532–548.  https://doi.org/10.1007/s00586-015-3898-x CrossRefGoogle Scholar

Copyright information

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

Authors and Affiliations

  1. 1.Scoliosis and Spine Tumor Center, Texas Back InstituteTexas Health Presbyterian Hospital PlanoPlanoUSA

Personalised recommendations