title: Subsequent, unplanned spine surgery and life survival of patients operated for neuropathic spine deformity.
abstract: METHODS
  Retrospective study of a prospectively assembled cohort.
  
  
  OBJECTIVE
  To characterize the survival from subsequent spine surgery and the life survival of patients treated surgically for severe spinal deformity due to neuropathic diseases.
  
  
  BACKGROUND
  Survivorship analysis is widely used to study the natural history of disease processes and of treatments provided, but has very seldom been used to study patients' course after surgery for spinal deformity associated with neuropathic diseases.
  
  
  METHODS
  Patients with neuropathic spinal deformity treated with primary posterior instrumentation and arthrodesis from 1989 through 2002 were identified and studied by review of charts and radiographs, and by mail survey. Subsequent spine surgery and death events, and the time interval from surgery were identified. Fifteen variables possibly influencing survivorship were studied.
  
  
  RESULTS
  There were no perioperative deaths, spinal cord injuries, or acute wound infections in the 117 eligible patients. Reoperation and life survival statuses were available for 110 patients (94%) at an average follow-up of 11.89 years (±5.3; range: 2-20.9 yr). Twelve patients (11%) had subsequent spine surgery. Survival from subsequent spine surgery was 91% at 5 years, 90% at 10 and 15 years, and 72% at 20 years. Proximal fixation problems occurred in 4 patients. Twenty-two patients (20%) had died from 4 to 20 years postoperative. Life survival was 98% at 5 years, 89% at 10 years, 81% at 15 years, and 56% at 20 years. The only variable associated with life survival was the occurrence of one or more perioperative complications, P = 0.0032. The younger half of the series at operation (<13.75 yr) was significantly more likely to have one or more perioperative complications, P = 0.0068. Spinal deformity type and magnitude were similar for the younger and older halves of the patients. Life survival of the patients with cerebral-palsy and not-cerebral-palsy upper motor neuron disease was not different. One-hundred-two of 105 were at least satisfied or would have the surgery again for the same condition.
  
  
  CONCLUSIONS
  Survival from subsequent spine operation was similar to adolescent idiopathic scoliosis series studied in the same manner. Life survival decline began at 4 years postoperative and was significantly associated with the occurrence of one or more perioperative complications. Even after successful spine deformity surgery, this population's health status is often precarious.
authors.affiliation: Kansas University Medical Center, Department of Orthopedic Surgery, Kansas City, KS 66160, USA. masher@kumc.edu
authors.forename: Marc A
authors.initials: MA
authors.lastname: Asher
authors.forename: Sue-Min
authors.initials: SM
authors.lastname: Lai
authors.forename: Douglas C
authors.initials: DC
authors.lastname: Burton
mesh_terms: D000293:Adolescent; D002493:Central Nervous System Diseases / Q000401:mortality / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D007615:Kansas / Q000453:epidemiology; D008297:Male; D009421:Nervous System Malformations / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D013131:Spine / Q000002:abnormalities*; D015996:Survival Rate; D055815:Young Adult