Abstract
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: 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: 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: 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: 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.
| Original language | English (US) |
|---|---|
| Journal | World Neurosurgery |
| DOIs | |
| State | Published - Jan 1 2019 |
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Keywords
- Adult spinal deformity
- Complications
- Minimally invasive
- Staging
- Surgery
ASJC Scopus subject areas
- Surgery
- Clinical Neurology
Cite this
Analysis of Complications with Staged Surgery for Less Invasive Treatment of Adult Spinal Deformity. / International Spine Study Group.
In: World Neurosurgery, 01.01.2019.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Analysis of Complications with Staged Surgery for Less Invasive Treatment of Adult Spinal Deformity
AU - International Spine Study Group
AU - Than, Khoi
AU - Park, Paul
AU - Tran, Stacie
AU - Mundis, Gregory M.
AU - Fu, Kai Ming
AU - Uribe, Juan S.
AU - Okonkwo, David O.
AU - Nunley, Pierce D.
AU - Fessler, Richard G.
AU - Eastlack, Robert K.
AU - Kanter, Adam
AU - Anand, Neel
AU - LaMarca, Frank
AU - Passias, Peter G.
AU - Mummaneni, Praveen V.
PY - 2019/1/1
Y1 - 2019/1/1
N2 - 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: 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: 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: 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: 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.
AB - 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: 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: 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: 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: 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.
KW - Adult spinal deformity
KW - Complications
KW - Minimally invasive
KW - Staging
KW - Surgery
UR - http://www.scopus.com/inward/record.url?scp=85064268829&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85064268829&partnerID=8YFLogxK
U2 - 10.1016/j.wneu.2019.03.090
DO - 10.1016/j.wneu.2019.03.090
M3 - Article
C2 - 30898739
AN - SCOPUS:85064268829
JO - World Neurosurgery
JF - World Neurosurgery
SN - 1878-8750
ER -