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Complications and Risk Factors of Primary Adult Scoliosis Surgery: A Multicenter Study of 306 Patients: *Paper #32

Charosky, Sebastien MD; Guigui, Pierre; Blamoutier, Arnaud; Roussouly, Pierre MD; Chopin, Daniel

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Spine Journal Meeting Abstracts: 2010 - Volume - Issue - p 69–70
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Summary: Multicenter study of 306 patients operated for primary adult or degenerative scoliosis. Complications and risk factors as well as survival curves are analyzed. Overall complication rate was 39% and 26% of the patients were reoperated for mechanical or neurological complications. Risk factors include number of instrumented vertebra, fusion to the sacrum, pso, and pre‐op pelvic tilt≥26°. Half of the patients are at riskfor a new operation in the 6 year period following the primary procedure

Introduction: Adult deformity surgery is associated with a high rate of complications. This multicenter study describes complications rate and risk factors as well as survival curves

Methods: A retrospective review of prospectively collected data from 6 centers in France.306 Primary lumbar adult or degenerative scoliosis patients aged over 50 operated between 2002‐2007were included. Demographics, comorbidities, xray parameters, surgical data and complications were analyzed. Statistical analysis was performed to obtain correlations and risk factors for complications. Reoperation risk was calculated with Kaplan Meier survival curves

Results: 306 patients age 63 yrs (range 50‐83)with 83% females. Mean CIRS was 5 (range 0‐26). Main curve was 50° (range 4‐96) with apex between T12 and L2. 10% patients had anterior surgery only, 18% double ant‐post and 72% posterior only. 74%(226 patients) had long fusions ≥ 3 levels and 44%(134 patients) were fused to the sacrum. 40% (122 patients) had a decompression performed and 18% an osteotomy. There were 175 complications for 119 patients (39%). No deaths, no blindness. General complication rate 13,7%; Early infection appeared in 4%(12patients) and late infection in 1,2%. Neurologic complications were present in 7% with 2 cases(0,6%)of late cord level deficits, and 12 reoperations(4%).Prevalence of mechanical complications was 24%(73 patients)with 58 patients (19%) needing a reoperation. Risk factors for mechanical or neurological complications were number of instrum vertebra (p≤0,01) fusion to the sacrum(p≤0,001),PSO (p=0,01)and a high pre‐op pelvic tilt≥26°(p≤0,05).Kaplan Meier survival curves showed reoperation risk of 44% at 70 months. Long fusions risk was 40% at 50 months and fusions to the sacrum reoperation risk of 48% at 49 months

Conclusion: Overall complication rate was 39% and 26% of the patients were reoperated for mechanical or neurological complications. Risk factors include number of instrumented vertebra, fusion to the sacrum, pso and pre‐op pelvic tilt≥26°. There is a 44% risk of a new operation in the 6 year period following the primary procedure

Significance: Surgeons should inform patients that there is a high risk of complications with a reoperation risk of 44% in the 6 year period following primary surgery

© 2010 Lippincott Williams & Wilkins, Inc.