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Prevalence and Indications for Unplanned Reoperations Following Index Surgery in the Adult Symptomatic Lumbar Scoliosis NIH-Sponsored Clinical Trial

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Abstract

Study Design

Longitudinal cohort.

Objective

To report on the prevalence and indications for unplanned reoperations following index surgery in the Adult Symptomatic Lumbar Scoliosis NIH-sponsored Clinical Trial.

Summary of Background Data

Reoperation following adult spinal deformity surgery exposes the patient to additional surgical risk, increases the cost of care, and decreases the potential cost-effectiveness of the intervention. Accurate data regarding the prevalence and indication for reoperation will facilitate future efforts to minimize risk.

Methods

A total of 153 patients underwent adult spinal deformity surgery as part of the observational, randomized, or crossover groups and were eligible for two-year follow-up. Reoperations were meticulously tracked as part of the National Institutes of Health (NIH)–mandated serious adverse event (SAE) reporting. The primary indication for reoperation was obtained from the treating surgeon’s operative report.

Results

Thirty-two patients had one reoperation, two patients underwent two reoperations, and three patients underwent three reoperations. A total of 45 reoperations were performed in 37 patients. Eleven patients (7%) underwent reoperation within 90 days of the index surgery: two for superficial wound dehiscence, three for radiculopathy with screw removal, and six for acute proximal junctional failure (PJF). Four patients underwent reoperation for PJF more than 90 days from index surgery. Twenty-six patients underwent 28 reoperations for rod fracture/pseudoarthrosis.

Conclusion

In a consecutive series of adult spinal deformity surgery patients with meticulous follow-up, 24% of patients required an unplanned reoperation. The most common indication for reoperation was rod fracture/pseudoarthrosis, which occurred from 9 months to 3.7 years following the index surgery and accounted for 62% (28/45) of the reoperations. The second most common indication for reoperation was PJF, which occurred from 1 month to 1.6 years following index surgery and accounted for 22% (10/45) of the reoperations. As these complications will likely increase with longer follow-up, efforts to lower the rates of these complications are warranted.

Level of Evidence

Level II.

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Authors and Affiliations

  1. Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, 40202, Louisville, KY, USA

    Charles H. Crawford III MD, Steven D. Glassman MD & Leah Y. Carreon MD, MSc

  2. Department of Orthopaedic Surgery, University of Louisville School of Medicine, 550 S. Jackson St., 1st Floor ACB, 40202, KY, Louisville, USA

    Charles H. Crawford III MD & Steven D. Glassman MD

  3. Department of Neurosurgery, University of Virginia, PO Box 800212, 22908, Charlottesville, VA, USA

    Christopher I. Shaffrey MD

  4. Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, NMH/Arkes Family Pavilion Suite 2210, 676 N Saint Clair Street, 60611, Chicago, IL, USA

    Tyler R. Koski MD

  5. Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8233, 63110, St. Louis, MO, USA

    Christine R. Baldus RN, MHA & Keith H. Bridwell MD

Authors
  1. Charles H. Crawford III MD
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  2. Steven D. Glassman MD
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  3. Leah Y. Carreon MD, MSc
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  4. Christopher I. Shaffrey MD
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  5. Tyler R. Koski MD
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  6. Christine R. Baldus RN, MHA
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  7. Keith H. Bridwell MD
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Corresponding author

Correspondence to Leah Y. Carreon MD, MSc.

Additional information

Author disclosures: Charles H. Crawford (grant to institution from the National Institutes of Health [NIH], related to the submitted work; consultancy fees from Alphatec and Medtronic; employee of Norton Healthcare and University of Louisville; grants or grants pending to institution from NIH, the Orthopedic Research and Educational Fund, Norton Healthcare; personal fees from DePuy Synthes, NASS committee meetings, and Scoliosis Research Society committee meetings, and other outside the submitted work), SDG (grant to institution from the National Institutes of Health, related to the submitted work; consultancy fees from Medtronic and Norton Healthcare; grant to institution from Norton Healthcare; payments for patents and royalties from Medtronic; and other from NuVasive, outside the submitted work [NuVasive provides funds directly to database company. No funds are paid directly to Individual or Individual’s Institution, 06/2012-04/2015]), LYC (grant to institution from the National Institutes of Health [NIH], related to the submitted work; board membership fees from University of Louisville Institutional Review Board [Institutional Review Board member] and the Scoliosis Research Society [Research Committee Member]; consultancy fees from Washington University at St. Louis and AO Spine; employee of Norton Healthcare, grants to institution from the Orthopedic Research and Educational Fund [Research Funding for Minimize Implants Maximize Outcomes RCT, 2013-current], Scoliosis Research Society [Research Funding for study: Evidence-based algorithm for the surgical treatment of lumbosacral spondylolisthesis-current]), travel support from the University of Louisville Institutional Review Board, Association for Collaborative Spine Research, Center for Spine Surgery and Research, Region of Southern Denmark; other from NuVasive [NuVasive provides funds directly to database company. No funds are paid directly to Individual or Individual’s Institution, 06/2012-04/2015]), and CIS (grant to institution from the National Institutes of Health [NIH], related to the submitted work; royalties from Biomet, Medtronic, and NuVasive; owns stock in NuVasive, receives consultancy fees from K2M and Stryker; board membership fees from AANS and CSRS; grants from NIH, Department of Defense, and ISSG Foundation; fellowship support from AO and NREF), TRK (grant to institution from the National Institutes of Health [NIH], related to the submitted work; Scoliosis Research Society, Spine Deformity; consultancy fee from Medtronic, NuVasive, Spinewave; grants to institution from Medtronic; and stock/stock options in NuVasive), CRB (grant to institution from the National Institutes of Health [NIH], related to the submitted work), KHB (grant to institution from the National Institutes of Health [NIH], related to the submitted work; royalties from Wolters Kluwer).

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Crawford, C.H., Glassman, S.D., Carreon, L.Y. et al. Prevalence and Indications for Unplanned Reoperations Following Index Surgery in the Adult Symptomatic Lumbar Scoliosis NIH-Sponsored Clinical Trial. Spine Deform 6, 741–744 (2018). https://doi.org/10.1016/j.jspd.2018.04.006

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  • DOI: https://doi.org/10.1016/j.jspd.2018.04.006

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