title: Morbidity and mortality in adult spinal deformity surgery: Norwich Spinal Unit experience.
abstract: OBJECTIVE
  This study analyses the complications of spinal deformity surgery in adults to highlight pre-disposing factors.
  
  
  METHODS
  The clinical records and imaging were reviewed for 48 consecutive patients, 12 males and 36 females, with a mean age of 64 (31-86), who had surgery for spinal deformity. Mean follow-up time was 36 months (24-60). Patient data recorded were age, diagnosis and co-morbidities; deformity assessment: curve type, sagittal and coronal balance, Cobb angle. Operation details: number of instrumented levels, duration and intra-operative complications.
  
  
  RESULTS
  complications, re-operations, balance and Cobb angle.
  
  
  RESULTS
  28 patients (58 %) had at least 1, 15 patients (27 %) had 2 and 5 patients (9.5 %) had more than 2 co-morbidities. Average time between 1st presentation and operation was 13 months (1-41). The mean number of levels fused was 10.8 (4-23). In addition to posterior pedicle screw instrumentation, 40 patients had chevron osteotomies and 8 had pedicle substraction osteotomies. Posterior interbody fusions were performed at one level in 17 of which 7 had 2 level fusion. Two patients had combined anterior and posterior approaches. Fusion to the pelvis was performed in 19 patients. There were a total of 27 major and minor complications in 19/48 (39.5 %) patients. Late complications included 5 patients who had revisions for proximal junctional kyphosis, 1 patient had revision for pseudoarthrosis and 4 patients had removal of mal-positioned screws.
  
  
  CONCLUSIONS
  Factors associated with high complication rate in adult spinal deformity surgery are age, co-morbidities and severe sagittal imbalance at the time of presentation.
authors.affiliation: Department of Orthopaedic Surgery, Norfolk and Norwich University Hospital, Colney lane, Norwich, Norfolk, NR4 7UY, UK. Shaishav.bhagat@yahoo.co.uk
authors.forename: Shaishav
authors.initials: S
authors.lastname: Bhagat
authors.forename: V
authors.initials: V
authors.lastname: Vozar
authors.forename: L
authors.initials: L
authors.lastname: Lutchman
authors.forename: R J
authors.initials: RJ
authors.lastname: Crawford
authors.forename: A S
authors.initials: AS
authors.lastname: Rai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects* / Q000401:mortality; D011859:Radiography; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013121:Spinal Curvatures / Q000000981:diagnostic imaging / Q000601:surgery*; D013131:Spine / Q000000981:diagnostic imaging / Q000601:surgery*; D006113:United Kingdom / Q000453:epidemiology