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Scoliosis Research Society Morbidity and Mortality of Adult Scoliosis Surgery

Sansur, Charles A. MD, MHSc*; Smith, Justin S. MD, PhD; Coe, Jeff D. MD; Glassman, Steven D. MD; Berven, Sigurd H. MD§; Polly, David W. Jr. MD; Perra, Joseph H. MD#; Boachie-Adjei, Oheneba MD**; Shaffrey, Christopher I. MD

doi: 10.1097/BRS.0b013e3182059bfd

Study Design. A retrospective review.

Objective. To obtain an assessment of complication incidence using the largest known database of adult scoliosis and to determine whether the rate of complication depends on various clinical parameters.

Summary of Background Data. The Scoliosis Research Society (SRS) morbidity and mortality database has previously been used to assess complication rates in adolescents undergoing scoliosis correction. To better understand complications in adults, degenerative and idiopathic adult scoliosis (AS) cases were studied.

Methods. The SRS morbidity and mortality database was queried to identify cases of AS from 2004 to 2007. Complications were identified and analyzed on the basis of patient type of scoliosis (degenerative vs. adult idiopathic), age, use of osteotomy, revision surgery status, and surgical approach. Age was stratified into less than or equal to 60 and greater than 60. Surgical approach was stratified into anterior only, posterior only, and combined anterior/posterior.

Results. A total of 4980 cases of AS were submitted from 2004 to 2007. There were 521 patients with complications (10.5%), and a total of 669 complications (13.4%). The most common complications were dural tear 142 (2.9%), superficial wound infection 46 (0.9%), deep wound infection 73 (1.5%), implant complication 80 (1.6%), acute neurological deficits 49 (1.0%), delayed neurological deficits 41 (0.5%), epidural hematoma 12 (0.2%), wound hematoma 22 (0.4%), pulmonary embolus 12 (0.2%), and deep venous thrombosis 9 (0.2%). There were 17 deaths (0.3%). There were 2555 patients with degenerative and 2425 patients with adult idiopathic scoliosis. Complication rates in these two groups were not significantly different (11.0% and 9.9%, respectively, P = 0.20). Age was not associated with complication rate (P = 0.32). Significantly higher complication rates were identified in osteotomies, revision surgery, and/or combined anterior-posterior surgery (P = 0.0006, 0.006, and 0.03, respectively).

Conclusions. The overall complication rate for AS treatment is 13.4%. Complication rate is significantly higher when osteotomies, revision procedures, and combined anterior/posterior approaches are used. Complication rate is not influenced by scoliosis type or age.

This is a large retrospective review of the morbidity and mortality in the treatment of adult scoliosis in 4980 people. The overall complication rate is 13.4%. Complication rate is significantly higher in patients undergoing osteotomies, revision procedures, and combined anteriorposterior approaches but is not influenced by type of scoliosis or age.

*University of Maryland School of Medicine, Baltimore, MD

Department of Neurosurgery, University of Virginia Medical Center, Charlottesville VA, 22908

Silicon Valley Spine Institute, Campbell, CA

Norton Leatherman Spine Center, Louisville, KY

§Department of Ortho Surgery, University of California–San Francisco, San Francisco, CA

Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN

#Twin Cities Spine Center, Minneapolis, MN

**Hospital for Special Surgery, New York, NY

Address correspondence and reprint requests to Charles A. Sansur, MD, MHSc, University of Maryland School of Medicine, Department of Neurosurgery, 22 S. Greene St, S-12-D, Baltimore, MD 21201; E-mail:

Acknowledgment date: December 7, 2009. Revision date: March 1, 2010. Acceptance date: March 8, 2010.

This study was performed without any financial support from industry or other organizations.

© 2011 Lippincott Williams & Wilkins, Inc.