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The postoperative course of mechanical complications in adult spinal deformity surgery

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Abstract

Purpose

(a) Describe the time course of each mechanical complication, and (b) compare radiographic measurements and preoperative patient-reported outcome measures (PROMs) among each mechanical complication type.

Methods

A single-institution case–control study was undertaken of patients undergoing adult spinal deformity (ASD) surgery from 2009–2017. Exposure variables included patient demographics, operative variables, radiographic measurements, and preoperative PROMs, including Oswestry Disability Index (ODI), Numeric Rating Scale Back/Leg-pain scores (NRS-Back/Leg), and EuroQol-5D (EQ-5D). The primary outcomes were occurrence of a mechanical complication and time to complication. Due to overlapping occurrence, rod fracture and pseudarthrosis were grouped into one composite category.

Results

145 patients underwent ASD surgery and were followed for at least 2 years. 30/47 (63.8%) patients with proximal junctional kyphosis (PJK) required reoperation, whereas 27/31 (87.1%) patients with pseudarthrosis/rod fracture required reoperation (63.8% vs. 87.1%, Χ2 = −0.23, 95% CI −0.41, −0.05, p = 0.023). Cox regression showed no significant difference in time to reoperation between PJK and rod fracture/pseudarthrosis (HR = 0.97, 95% CI 0.85–1.11, p = 0.686). Distal junctional kyphosis (DJK) (N = 3; 2 reoperation) and implant failures (N = 4; 0 reoperations) were rare. Patients with PJK had significantly lower Hounsfield Units preoperatively compared to those with pseudarthrosis/rod fracture (138.2 ± 43.8 vs. 160.3 ± 41.0, mean difference (MD) =  −22.1, 95% CI −41.8, −2.4, p = 0.028), more prior fusions (51.1% vs. 25.8%, Χ2 = 0.253, 95% CI 0.41, 0.46, p = 0.026), fewer instrumented vertebrae (9.2 ± 2.6 vs. 10.7 ± 2.5, MD =  −1.5, 95% CI −2.7, −0.31, p = 0.013), and higher postoperative thoracic kyphosis (TK) (46.3 ± 12.7 vs. 34.9 ± 10.6, MD = 11.4, 95% CI 5.9, 16.9, p < 0.001). Higher postoperative C7 sagittal vertical axis (SVA) did not achieve a significant difference (80.7 ± 72.1 vs. 51.9 ± 57.3, MD = 28.8, 95% CI −1.9, 59.5, p = 0.066). No differences were seen in preoperative PROMs.

Conclusion

Patients with pseudarthrosis/rod fracture had a higher reoperation rate compared to those with PJK with similar time to reoperation. Moreover, patients with PJK had higher postoperative TK, lower Hounsfield Units, more prior fusions, and fewer instrumented levels compared to those with pseudarthrosis/rod fracture. The results of this single-institution study suggest that even though mechanical complications are often analyzed as a single group, important differences may exist between them.

Level of evidence

III.

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Funding

This study did not receive funding from any institution or grant.

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Authors and Affiliations

  1. Department of Neurological Surgery, Vanderbilt University Medical Center, Medical Center North T-4224, Nashville, TN, 37212, USA

    Hani Chanbour, Steven G. Roth, Amir M. Abtahi, Byron F. Stephens & Scott L. Zuckerman

  2. Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA

    Matthew E. LaBarge, Anthony M. Steinle, Amir M. Abtahi, Byron F. Stephens & Scott L. Zuckerman

  3. Department of Orthopedic Surgery, University of Texas Health Science Center-San Antonio, San Antonio, TX, USA

    Jeffrey Hills

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  1. Hani Chanbour
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Contributions

HC, SGR: data curation, drafting the paper. MEL, AMS: design and execution of the formal analysis. JH: designed research, conceptualization, interpretation of the analysis. AMA, BFS: conducted review and editing. SLZ: designed research, data acquisition, conceptualization, interpretation of the analysis. Final approval of the version to be published. All authors are contributed effort to the study.

Corresponding author

Correspondence to Scott L. Zuckerman.

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Conflict of interest

The other authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. The authors have no personal or institutional financial interest in drugs, materials, or devices described in their submissions.

Ethical approval

This study was approved by the IRB committee at Vanderbilt University Medical Center (IRB#211290). We certify that the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Supplementary file1 Supplementary Information. Baseline comparison of demographics and perioperative variables between those with and without 2-year follow-up (DOCX 15 KB)

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Chanbour, H., Roth, S.G., LaBarge, M.E. et al. The postoperative course of mechanical complications in adult spinal deformity surgery. Spine Deform 11, 175–185 (2023). https://doi.org/10.1007/s43390-022-00576-8

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