Abstract
Purpose
The treatment of adult scoliosis is a challenge especially in patients over 50 years old with severe, rigid curves in whom the use of vertebral osteotomies may be necessary to correct the deformity. The aim the study was to analyse the perioperative complications related to vertebral osteotomies in elderly treated for spinal deformity.
Methods
We analysed 72 consecutive cases of kyphoscoliosis, we classify them according to Berjano–Lamartina classification. We divided patients into two groups: we only practised SPO and/or PO in patients that composed group A; we practised also PSO in patients that composed group B. We retrospectively analysed the perioperative complications and radiographical results. Average follow-up was 30 months.
Results
We had 50 cases of degenerative segment diseases (DSD) Type III, 13 Type IVa DSD and 9 Type IVb DSD. Mean age was 60.7 years old. Overall complication rate was 22.2 %. In group A, the complication rate was 16.9 % while in group B it was 46.2 %. Mean Cobb primary curve angle was 41.75° with average C7 plumb line (C7PL) of 4.49 cm, residual scoliosis after surgery was 15.41° and average C7PL of 2.08 cm, with statistically significant differences.
Conclusions
Previous studies have shown increased complication rates with vertebral osteotomies in elderly patients, our experience support this evidence. Our study demonstrates a high incidence of intraoperative complication rate in elderly patients underwent a PSO. PSO is a demanding technique to be considered in very selected and motivated patients who must be carefully informed about the risks of the procedure.
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References
Aebi M (2005) The adult scoliosis. Eur Spine J 14:92548
Daubs KD, Lenke LG, Chen G, Stobbs G, Bridwell KH (2007) Adult spinal deformity surgery. Complications and outcomes in patients over age 60. Spine 32:2238–2244
Carreon LY, Puno RM, Dimar JR II et al (2003) Perioperative complications of posterior lumbar decompression and arthrodesis in older patients. J Bone Joint Surg Am 85:2089–2092
Berjano P, Pejrona M, Damilano M, Cecchinato R, Aguirre MF, Lamartina C (2015) Corner osteotomy: a modified pedicle subtraction osteotomy for increased sagittal correction in the lumbar spine. Eur Spine J 24(Suppl 1):58–65. doi:10.1007/s00586-014-3618-y
Enercan M, Ozturk C, Kahraman S, Sarier M, Hamzaoglu A, Alanay A (2013) Osteotomies/spinal column resections in adult deformity. Eur Spine J 22(Suppl 2):S254–S264. doi:10.1007/s00586-012-2313-0
Auerbach JD, Lenke LG, Bridwell KH et al (2012) Major complications and comparison between 3-column osteotomy techniques in 105 consecutive spinal deformity procedures. Spine (Phila Pa 1976) 37:1198–1210
Berjano P, Lamartina C (2014) Classification of degenerative segment disease in adults with deformity of the lumbar or thoracolumbar spine. Eur Spine J 23(9):1815–1824. doi:10.1007/s00586-014-3219-9 (Epub 2014 Feb 23)
Le Huec JC, Aunoble S, Leijssen P, Pellet N (2011) Pelvic parameters: origin and significance. Eur Spine J 20(Suppl 5):S564–S571
Benz RJ, Ibrahim ZG, Afshar P et al (2001) Predicting complications in elderly patients undergoing lumbar decompression. Clin Orthop 384:116–121
Carreon LY, Puno RM, Dimar JR II et al (2003) Perioperative complications of posterior lumbar decompression and arthrodesis in older patients. J Bone Joint Surg Am 85:2089–2092
Deyo RA, Ciol MA, Cherkin DC et al (1993) Lumbar spinal fusion: a cohort study of complications, reoperations, and resource use in the Medicare population. Spine 18:1463–1470
Cassinelli EH, Eubanks J, Vogt M, Furey C, Yoo J, Bohlman HH (2007) Risk factors for the development of perioperative complications in elderly patients undergoing lumbar decompression and arthrodesis for spinal stenosis: an analysis of 166 patients. Spine (Phila Pa 1976) 32:230–235
Buchowski JM, Bridwell KH, Lenke LG, Kuhns CA, Lehman RA Jr, Kim YJ, Stewart D, Baldus C (2007) Neurologic complications of lumbar pedicle subtraction osteotomy: a 10-year assessment. Spine 32(20):2245–2252
Farjoodi P, Skolasky RL, Riley LH (2011) The effects of hospital and surgeon volume on postoperative complications after lumbarspine surgery. Spine 36:2069–2075
Drazin D, Shirzadi A, Rosner J, Eboli P, Safee M, Baron EM, Liu JC, Acosta FL Jr (2011) Complications and outcomes after spinal deformity surgery in the elderly: review of the existing literature and future directions. Neurosurg Focus 31(4):E3
DeWald CJ, Stanley T (2006) Instrumentation-related complications of multilevel fusions for adult spinal deformity patients over age 65: surgical considerations and treatment options in patients with poor bone quality. Spine 31(19 Suppl):S144–S151
Schizas C, Neumayer F, Kosmopoulos V (2008) Incidence and management of pulmonary embolism following spinal surgery occurring while under chemical thromboprophylaxis. Eur Spine J 17:970–974
Pull ter Gunne AF, Cohen DB (2009) Incidence, prevalence, and analysis of risk factors for surgical site infection following adult spinal surgery. Spine (Phila Pa 1976) 34(13):1422–1428
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 35:219–226
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La Maida, G.A., Luceri, F., Gallozzi, F. et al. Complication rate in adult deformity surgical treatment: safety of the posterior osteotomies. Eur Spine J 24 (Suppl 7), 879–886 (2015). https://doi.org/10.1007/s00586-015-4275-5
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DOI: https://doi.org/10.1007/s00586-015-4275-5