Outcomes of open staged corrective surgery in the setting of adult spinal deformity.
Adult spinal deformity (ASD) represents a constellation of complex malalignments affecting the spinal column. Corrective surgical procedures aimed at improving ASD can be equally challenging, and commonly require multiple index procedures and potential revisions before definitive management. There is a paucity of data comparing the outcomes of same-day(simultaneous [SIM]) and 2-day (staged [STA]) procedures for long spinal fusions for ASD. Using a large patient cohort with surgeon- and patient-reported outcomes will be particularly useful in determining the utility and effect of staging long spinal fusions for ASD.



This study aimed to compare intraoperative, perioperative, and 2-year outcomes of STA and SIM procedures correcting ASD.



This is a retrospective analysis of a prospective multicenter database.



A total of 142 patients (71 STA, 71 SIM) were included.



Primary outcome measures were intra- and perioperative (6 weeks) complication rates. Secondary outcome measures were 2-year thoracolumbar and spinopelvic radiographic parameters, 2-year health-related quality of life (HRQoL) changes (Oswestry Disability Index [ODI] and Short Form-36 [SF-36]), and 2-year complication rates.



Inclusion criteria included patients with ASD ≥18 years with 6-week and 2-year follow-up. Propensity score matching identified similar patients undergoing STA or SIM long spinal fusions based on surgical invasiveness, pelvic tilt, and sagittal vertical axis (SVA). Complications, HRQoL scores (Scoliosis Research Society-22 Patient Questionnaire [SRS-22r], SF-36, ODI), and patient characteristics were compared across and within treatment groups at follow-up with analysis of variance (ANOVA) and paired t tests at three surgical stages: intraoperatively, perioperatively (6 weeks), and postoperatively (>6 weeks).



A total of 142 patients were included (71 STA, 71 SIM). Matching STA and SIM groups based on degree of deformity and surgical invasiveness created two groups similar in overall correction of the surgery. Patients undergoing STA underwent more anterior lumbar interbody fusion (ALIF) and lateral lumbar interbody fusion (LLIF) procedures, whereas patients undergoing SIM had longer fusions. Charlson comorbidity index and revision status were similar between groups (p>.05). Staging procedures had significantly more complications causing reoperation (STA: 47% vs. SIM: 8%, p=.021), and had a greater number of perioperative complications requiring a return to the operating room (OR) (STA: 9.9% vs. SIM: 1.4%, p=.029). There was no difference in intraoperative complications, mortality, or perioperative infection or wound complications (p>.05) between the two procedures. At 2-year follow-up, incidence of revision surgery was higher in STA (STA: 21.1% vs. SIM: 8.5%, p=.033).



Staged spinal fusions, which add ALIFs and LLIFs to the procedure, compared with similar-correction SIM procedures, result in similar intraoperative complication incidence, but significantly higher rates of peri- and postoperative complications leading to revision. Functional outcomes, radiographic parameters, and mortality were similar. This will aid surgeons in their determination of the optimal treatment for such complex procedures.
NYU Medical Center-Hospital for Joint Diseases, 301 E 17th St, New York, NY 10003, USA. Electronic address: peter.passias@nyumc.org.
Peter G
PG
Passias
NYU Medical Center-Hospital for Joint Diseases, 301 E 17th St, New York, NY 10003, USA.
Gregory W
GW
Poorman
NYU Medical Center-Hospital for Joint Diseases, 301 E 17th St, New York, NY 10003, USA.
Cyrus M
CM
Jalai
Rocky Mountain Spine, 1601 E 19th Ave, Denver, CO 80218, USA.
Breton
B
Line
Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA.
Bassel
B
Diebo
University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA.
Paul
P
Park
Oregon Health and Science University, 3303 SW Bond Ave, Portland, OR 97239, USA.
Robert
R
Hart
University of Kansas, 1450 Jayhawk Blvd, Kansas City, KS 66045,USA.
Douglas
D
Burton
Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA.
Frank
F
Schwab
Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA.
Virginie
V
Lafage
NYU Medical Center-Hospital for Joint Diseases, 301 E 17th St, New York, NY 10003, USA.
Shay
S
Bess
NYU Medical Center-Hospital for Joint Diseases, 301 E 17th St, New York, NY 10003, USA.
Thomas
T
Errico
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011788:Quality of Life; D012086:Reoperation / Q000706:statistics & numerical data; D012600:Scoliosis / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods*; D013131:Spine / Q000601:surgery
Adult spinal deformity; Complications; Lumbar fusion; Outcomes; Simultaneous; Staged