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Revision surgery following long lumbopelvic constructs for adult spinal deformity: prospective experience from two dedicated databases

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A Correction to this article was published on 31 October 2023

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Abstract

Purpose

Pan Lumbar Arthodesis (PLA) are often required for Adult Spinal Deformity (ASD) correction, reducing significantly the compensatory capacity in case of postoperative sagittal malalignment. Few papers have investigated outcomes and complications in this vulnerable subset of patients. The objective of this study was to assess revision surgery rate for PLA in ASD, its risk factors and impact on clinical outcomes.

Methods

Retrospective multicenter review of prospective ASD data from 7 hospitals covering Europe and Asia. ASD patients included in two prospective databases having a posterior instrumentation spanning the whole lumbar region with more than 2-years of follow-up were reviewed. Demographic, surgical, radiographic parameters and Health-Related Quality of Life (HRQoL) scores were analyzed. Univariate and multivariate regression models analyzed risk factors for revision surgery as well as surgical outcomes. Patients with Early versus Late and PJK versus Non-PJK mechanical complications were also compared.

Results

Out of 1359 ASD patients included in the database 589 (43%) had a PLA and 357 reached 2-years mark. They were analyzed and compared to non-PLA patients. Average age was 67 and 82% were females. 100 Patients (28.1%) needed 114 revision surgeries (75.4% for mechanical failures). Revised patients were more likely to have a nerve system disorder, higher BMI and worst immediate postoperative alignment (as measured by GAP Parameters). These risk factors were also associated with earlier mechanical complications and PJK. Deformity and HRQoL parameters were comparable at baseline. Non-revised patients had significantly better clinical outcomes at 2-years (SRS 22 scores, ODI, Back pain). Multivariate analysis could identify nerve system disorder (OR 4.8; CI 1.8–12.6; p = 0.001), postoperative sagittal alignment (GAP Score) and high BMI (OR 1.07; CI 1.01–1.13; p = 0.004) as independent risk factors for revisions.

Conclusions

Revision surgery due to mechanical failures is relatively common after PLA leading to worse clinical outcomes. Prevention strategies should focus on individualized restoration of sagittal alignment and better weight control to decrease stress on these rigid constructs in non-compliant spines. Nerve system disorders independently increase revision risk in PLA.

Level of evidence II

Prognosis.

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Acknowledgements

Emre Acaroğlu; M.D PhD. For his invaluable labor in the foundation of the ESSG, his contribution to the success of group, his commitment in recruitment and follow-up of patients and his continuous scientific and logistic support.

Funding

The European Spine Study Group receives funding support from DePuy Synthes and Medtronic.

Author information

Authors and Affiliations

  1. Spine Research Unit, Vall d’Hebron Research Institute, Barcelona, Spain

    Sleiman Haddad, Alba Vila-Casademunt, Susana Nuñez-Pereira, Manuel Ramirez & Ferran Pellisé

  2. Spine Surgery Unit, Vall d’Hebron University Hospital, Pg Vall Hebron 119-129, 08035, Barcelona, Spain

    Sleiman Haddad, Susana Nuñez-Pereira, Manuel Ramirez & Ferran Pellisé

  3. Department of Orthopedic Surgery, Iwata City Hospital, Iwata-City, Shizuoka, Japan

    Tatsuya Yasuda

  4. Department of Orthopedics and Traumatology, Acibadem University, Istanbul, Turkey

    Çaglar Yilgor & Ahmet Alanay

  5. Spine Surgery Unit, La Paz University Hospital, Madrid, Spain

    Javier Pizones & Francisco Javier Sánchez Pérez-Grueso

  6. Spine Center Division, Schulthess Klinik, Zurich, Switzerland

    Frank Kleinstuck

  7. Spine Surgery Unit, Bordeaux University Hospital, Bordeaux, France

    Ibrahim Obeid

  8. Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu-City, Shizuoka, Japan

    Yukihiro Matsuyama

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  1. Sleiman Haddad
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  11. Francisco Javier Sánchez Pérez-Grueso
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European Spine Study Group

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Correspondence to Sleiman Haddad.

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Ethical approval

IRB approval was obtained through each of the member sites contributing cases. Patients signed individual conscent form to be included in this database.

Conflict of interest

Grants, technical support, and corporate support: The European Spine Study Group receives funding support from DePuy Synthes and Medtronic. No other conflicts of interests exist with the presented data.

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Haddad, S., Yasuda, T., Vila-Casademunt, A. et al. Revision surgery following long lumbopelvic constructs for adult spinal deformity: prospective experience from two dedicated databases. Eur Spine J 32, 1787–1799 (2023). https://doi.org/10.1007/s00586-023-07627-2

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