title: Short-term morbidity and mortality associated with correction of thoracolumbar fixed sagittal plane deformity: a report from the Scoliosis Research Society Morbidity and Mortality Committee.
abstract: METHODS
  Retrospective review.
  
  
  OBJECTIVE
  Our objective was to assess the short-term complication rate in patients undergoing treatment of thoracolumbar fixed sagittal plane deformity (FSPD).
  
  
  BACKGROUND
  The reported morbidity and mortality for the surgical treatment of thoracolumbar FSPD is varied and based on studies with small sample sizes. Further studies are needed to better assess FSPD complication rate, and the factors that influence it.
  
  
  METHODS
  The Scoliosis Research Society (SRS) Morbidity and Mortality Database was queried to identify cases of thoracolumbar FSPD from 2004 to 2007. Complications were analyzed based on correction technique, surgical approach, surgeon experience (SRS membership status used as a surrogate), patient age, and history of prior surgery.
  
  
  RESULTS
  Five hundred and seventy-eight cases of FSPD were identified. Osteotomies were performed in 402 cases (70%), including 215 pedicle subtraction osteotomies (PSO), 135 Smith-Petersen osteotomies (SPO), 19 anterior discectomy with corpectomy procedures (ADC), 18 vertebral column resections (VCR), and 15 unspecified osteotomies. There were 170 complications (29.4%) in 132 patients. There were three deaths (0.5%). The most common complications were durotomy (5.9%), wound infection (3.8%), new neurologic deficit (3.8%), implant failure (1.7%), wound hematoma (1.6%), epidural hematoma (1.4%), and pulmonary embolism (1.0%). Procedures including an osteotomy had a higher complication rate (34.8%) than cases not including an osteotomy (17.0%, P < 0.001), and this remained significant after adjusting for the effects of patient age, surgeon experience, and history of prior surgery (P = 0.003, odds ratio = 2.070, 95% CI = 1.291-3.321). Not significantly associated with complication rate were patient age (P = 0.68), surgeon experience (P = 0.18), and history of prior surgery (P = 0.10). Complication rates were progressively higher from no osteotomy (17.0%), to SPO (28.1%), to PSO (39.1%), to VCR (61.1%).
  
  
  CONCLUSIONS
  The short-term complication rate for treatment of FSPD is 29.4%. The complication rate was significantly higher in patients undergoing osteotomies, and more aggressive osteotomies were associated with progressively higher complication rates.
authors.affiliation: Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA.
authors.forename: Justin S
authors.initials: JS
authors.lastname: Smith
authors.forename: Charles A
authors.initials: CA
authors.lastname: Sansur
authors.forename: William F
authors.initials: WF
authors.lastname: Donaldson
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Perra
authors.forename: Ram
authors.initials: R
authors.lastname: Mudiyam
authors.forename: Theodore J
authors.initials: TJ
authors.lastname: Choma
authors.forename: Reinhard D
authors.initials: RD
authors.lastname: Zeller
authors.forename: D Raymond
authors.initials: DR
authors.lastname: Knapp
authors.forename: Hilali H
authors.initials: HH
authors.lastname: Noordeen
authors.forename: Sigurd H
authors.initials: SH
authors.lastname: Berven
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Goytan
authors.forename: Oheneba
authors.initials: O
authors.lastname: Boachie-Adjei
authors.forename: Christopher I
authors.initials: CI
authors.lastname: Shaffrey
mesh_terms: D026683:Advisory Committees / Q000639:trends; D000368:Aged; D016208:Databases, Factual / Q000639:trends; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008875:Middle Aged; D009017:Morbidity; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000401:mortality*; D012189:Retrospective Studies; D012600:Scoliosis / Q000453:epidemiology / Q000401:mortality* / Q000601:surgery*; D012955:Societies, Medical / Q000639:trends; D013123:Spinal Fusion / Q000009:adverse effects / Q000401:mortality; D013904:Thoracic Vertebrae / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome