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Complications in adult spine deformity surgery: a systematic review of the recent literature with reporting of aggregated incidences

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Abstract

Purpose

To review the incidence of perioperative and late complications of surgery for spinal deformity (ASD).

Methods

Review of the literature. We reviewed recent literature in English to investigate the incidence of complications in ASD surgery in the perioperative (≤ 3 months post-operative) and late (> 3 months post-operative) periods. Randomized-controlled trials, non-randomized trials, cohort studies, case–control studies, and case series published in 2005 or later were included. We divided articles according to surgical technique: open procedures (OP), minimally invasive surgery (MIS), and hybrid procedures (HP). Complications were recorded, grouped by surgical technique, and then classified according to a proposed Grading of Incidence of Complications (IOC).

Results

Ninety-six publications reporting on 12,168 patients were included; 68 were level IV of evidence studies, 24 were level III, and 4 level II. Perioperative IOC was 26.5% in OP, 36.4% in HP, and 24.2% in MIS. Late IOC was 11.1% in OP, 15.4% in HP, and 14.0% in MIS. IOC was significantly higher for hybrid procedures compared to both open and MIS procedures.

Conclusions

Reported complications of surgery for ASD in the recent literature are frequent (24–36% perioperative plus 11–15% late). Open procedures were the most extensively reported in the literature. Complication rates are similar for OP and MIS. HP presented higher IOC likely due to the combination of OP and MIS respective complications. Small number of studies and heterogeneity in reporting could result in risk of bias in these results. Large-scale registry-based studies can fill this gap in the future.

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Authors and Affiliations

  1. Clinica Ortopedica, IRCCS AOU SAN MARTINO IST, Genoa, Italy

    Andrea Zanirato & Matteo Formica

  2. IRCCS Istituto Ortopedico Galeazzi, Milan, Italy

    Marco Damilano, Alessio Lovi & Pedro Berjano

  3. U.O.C. Ortopedia e Traumatologia Universitaria, Azienda Ospedaliero Universitaria Policlinico di Bari, Bari, Italy

    Andrea Piazzolla

  4. IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy

    Jorge Hugo Villafañe

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  1. Andrea Zanirato
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  2. Marco Damilano
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Zanirato, A., Damilano, M., Formica, M. et al. Complications in adult spine deformity surgery: a systematic review of the recent literature with reporting of aggregated incidences. Eur Spine J 27, 2272–2284 (2018). https://doi.org/10.1007/s00586-018-5535-y

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  • DOI: https://doi.org/10.1007/s00586-018-5535-y

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