@article{ccd2baba154148dbaecbc187fe9aa327,
title = "Analysis of Complications with Staged Surgery for Less Invasive Treatment of Adult Spinal Deformity",
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.",
keywords = "Adult spinal deformity, Complications, Minimally invasive, Staging, Surgery",
author = "{International Spine Study Group} and Than, {Khoi D.} and Paul Park and Stacie Tran and Mundis, {Gregory M.} and Fu, {Kai Ming} and Uribe, {Juan S.} and Okonkwo, {David O.} and Nunley, {Pierce D.} and Fessler, {Richard G.} and Eastlack, {Robert K.} and Adam Kanter and Neel Anand and Frank LaMarca and Passias, {Peter G.} and Mummaneni, {Praveen V.}",
note = "Funding Information: We thank Shirley McCartney, Ph.D. for editorial assistance. Conflict of interest statement: K. D. Than reports being a consultant for Bioventus and Medtronic. P. Park reports being a consultant for Globus Medical, NuVasive, Allosource, and Medtronic; receives royalties from Globus Medical; and receives research support from Pfizer and Vertex. G. M. Mundis reports being a consultant for NuVasive, K2M, Viseon, Seaspine, and Allosource; receives royalties from K2M and NuVasive; and is a speaker for DePuy. K-M. Fu reports being a consultant for SI-Bone, DePuy, Globus, and 4web. J. S. Uribe reports being a consultant for NuVasive and receives royalties from NuVasive. D. O. Okonkwo reports being a consultant for NuVasive, Zimmer Biomet, and Stryker; is a patent holder with Zimmer Biomet; and receives royalties from Zimmer Biomet and NuVasive. P. D. Nunley is a consultant for K2M; receives royalties from K2M and LDR; has stock or stock options in Amedica, Paradigm Spine, and Spineology; and receives research support from Mesoblast, Organogenesis, Pfizer, Seikagaku, Simplify, Spinal Kinetics, Spineology, Vertiflex, and Zimmer-Biomet. R. G. Fessler reports being a consultant for DePuy; receives royalties from DePuy; receives speaker fees from Benvenue; and has ownership in In Queue Innovations. R. K. Eastlack reports being a consultant for Aesculap, K2M, NuVasive, Seaspine, SI-Bone, Spine Innovation, and Titan; receives royalties from Globus Medical; has direct stock ownership in Carevature, DiFusion, NuVasive, Alphatec, Spine Innovation, Seaspine, and Invuity; has received clinical or research support for the present study from NuVasive, Scripps Clinic Medical Group, and Seaspine; and holds patents with Invuity, Globus Medical, and NuTech. A. Kanter receives royalties from NuVasive and Zimmer. N. Anand reports being a consultant for Medtronic and Spinal Balance; has direct stock ownership in Atlas Spine, Globus Medical, GYS Tech, Medtronic, Paradigm Spine, and Theracell; is a patent holder with Medtronic; and receives royalties from Medtronic, Globus Medical, and Elsevier. P. V. Mummaneni reports being a consultant for Globus, DePuy Spine, and Stryker; has direct stock ownership in Spinicity/ISD; receives support for a non?study-related clinical or research effort that he oversees from Neurosurgery Research and Education Foundation; receives honoraria from AOSpine and Spineart; and receives royalties from DePuy Spine, Thieme Publishers, Taylor and Francis, and Springer Publishers. Funding for the International Spine Study Group Foundation, through which this study was conducted, was provided by research grants from DePuy Spine and individual donations. Publisher Copyright: {\textcopyright} 2019 Elsevier Inc.",
year = "2019",
month = jun,
doi = "10.1016/j.wneu.2019.03.090",
language = "English (US)",
volume = "126",
pages = "e1337--e1342",
journal = "World Neurosurgery",
issn = "1878-8750",
publisher = "Elsevier Inc.",
}