Analysis of Complications with Staged Surgery for Less Invasive Treatment of Adult Spinal Deformity.

Adult Aged Female Humans Male Middle Aged Minimally Invasive Surgical Procedures / adverse effects Postoperative Complications / epidemiology Retrospective Studies Spinal Curvatures / surgery Spinal Fusion / methods Treatment Outcome
Adult spinal deformity Complications Minimally invasive Staging Surgery

Journal

World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275

Informations de publication

Date de publication:
Jun 2019
Historique:
received: 05 02 2019
revised: 08 03 2019
accepted: 09 03 2019
pubmed: 23 3 2019
medline: 14 1 2020
entrez: 23 3 2019
Statut: ppublish

Résumé

Spinal deformity surgery is often invasive and lengthy. Staging surgery over separate operative days may reduce complications. Staging is often used in minimally invasive treatment of adult spinal deformity (ASD). To investigate the impact of staging on complication rates between hybrid (HYB; minimally invasive interbody with open posterior screw and rod fixation) and circumferential minimally invasive surgery (cMIS; minimally invasive interbody and screw/rod placement) procedures in patients with ASD. A multicenter database of patients with ASD was reviewed. Patients who underwent staging (at least 3 levels) and 2 years of follow-up were analyzed. A total of 99 patients underwent staging: 53 cMIS and 46 HYB surgeries. Propensity matching for levels fused resulted in 19 patients in each group. Intra- and perioperative complications were assessed. Three HYB but no cMIS intraoperative complications occurred. More HYB patients had perioperative complications than cMIS patients. Neurologic complications were more frequent in HYB versus cMIS. Other complications did not differ significantly. Thirty-day reoperations were higher with cMIS than HYB, but there was no difference in reoperation rate at long-term follow-up. cMIS patients had greater improvement in the Oswestry Disability Index. There was no difference in complications between staged versus unstaged cMIS surgeries. cMIS staged surgeries appear safer than HYB staged surgeries, and equally safe to cMIS unstaged surgeries. Perioperative complications were significantly higher for HYB staged surgeries. HYB surgeries may have better results when performed in a single setting, whereas cMIS surgeries can be performed in 1 or 2 stages depending on surgeon preference.

Sections du résumé

BACKGROUND BACKGROUND
Spinal deformity surgery is often invasive and lengthy. Staging surgery over separate operative days may reduce complications. Staging is often used in minimally invasive treatment of adult spinal deformity (ASD).
OBJECTIVE OBJECTIVE
To investigate the impact of staging on complication rates between hybrid (HYB; minimally invasive interbody with open posterior screw and rod fixation) and circumferential minimally invasive surgery (cMIS; minimally invasive interbody and screw/rod placement) procedures in patients with ASD.
METHODS METHODS
A multicenter database of patients with ASD was reviewed. Patients who underwent staging (at least 3 levels) and 2 years of follow-up were analyzed. A total of 99 patients underwent staging: 53 cMIS and 46 HYB surgeries. Propensity matching for levels fused resulted in 19 patients in each group. Intra- and perioperative complications were assessed.
RESULTS RESULTS
Three HYB but no cMIS intraoperative complications occurred. More HYB patients had perioperative complications than cMIS patients. Neurologic complications were more frequent in HYB versus cMIS. Other complications did not differ significantly. Thirty-day reoperations were higher with cMIS than HYB, but there was no difference in reoperation rate at long-term follow-up. cMIS patients had greater improvement in the Oswestry Disability Index. There was no difference in complications between staged versus unstaged cMIS surgeries.
CONCLUSIONS CONCLUSIONS
cMIS staged surgeries appear safer than HYB staged surgeries, and equally safe to cMIS unstaged surgeries. Perioperative complications were significantly higher for HYB staged surgeries. HYB surgeries may have better results when performed in a single setting, whereas cMIS surgeries can be performed in 1 or 2 stages depending on surgeon preference.

Identifiants

DOI: 10.1016/j.wneu.2019.03.090 PMID: 30898739
pubmed: 30898739
pii: S1878-8750(19)30758-2
doi: 10.1016/j.wneu.2019.03.090
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

e1337-e1342

Informations de copyright

Copyright © 2019 Elsevier Inc. All rights reserved.

Auteurs

Khoi D Than (KD)

Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA. Electronic address: thank@ohsu.edu.

Paul Park (P)

Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.

Stacie Tran (S)

San Diego Center for Spinal Disorders, La Jolla, California, USA.

Gregory M Mundis (GM)

Division of Orthopaedic Surgery, Scripps Clinic Medical Group, La Jolla, California, USA.

Kai-Ming Fu (KM)

Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA.

Juan S Uribe (JS)

Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.

David O Okonkwo (DO)

Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.

Pierce D Nunley (PD)

Department of Neurosurgery, Spine Institute of Louisiana, Shreveport, Louisiana, USA.

Richard G Fessler (RG)

Department of Neurosurgery, Rush Medical College, Chicago, Illinois, USA.

Robert K Eastlack (RK)

Division of Orthopaedic Surgery, Scripps Clinic Medical Group, La Jolla, California, USA.

Adam Kanter (A)

Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.

Neel Anand (N)

Department of Orthopedics, Cedars-Sinai Medical Center, Los Angeles, California, USA.

Frank LaMarca (F)

Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan, USA.

Peter G Passias (PG)

Department of Orthopedic Surgery, New York Spine Institute, New York, New York, USA.

Praveen V Mummaneni (PV)

Department of Neurological Surgery, University of California, San Francisco, California, USA.
San Diego Center for Spinal Disorders, La Jolla, California, USA.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Analysis of Complications with Staged Surgery...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Analysis of Complications with Staged Surgery...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Analysis of Complications with Staged Surgery...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Adulte d'âge moyen › Analysis of Complications with Staged Surgery...
questionsmedicales.fr › Procédures de chirurgie opératoire › Interventions chirurgicales mini-invasives › Analysis of Complications with Staged Surgery...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Complications postopératoires › Analysis of Complications with Staged Surgery...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Analysis of Complications with Staged Surgery...
questionsmedicales.fr › Maladies ostéomusculaires › Maladies osseuses › Maladies du rachis › Déviations du rachis › Analysis of Complications with Staged Surgery...
questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures orthopédiques › Arthrodèse › Arthrodèse vertébrale › Analysis of Complications with Staged Surgery...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Qualité des soins de santé › Mécanismes d'évaluation des soins de santé › Évaluation des résultats et des processus en soins de santé › Évaluation de résultat (soins) › Résultat thérapeutique › Analysis of Complications with Staged Surgery...