Prospective Multicenter Assessment of Early Complication Rates Associated With Adult Cervical Deformity Surgery in 78 Patients

The International Spine Study Group

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

BACKGROUND:: Few reports have focused on treatment of adult cervical deformity (ACD). OBJECTIVE:: To present early complication rates associated with ACD surgery. METHODS:: A prospective multicenter database of consecutive operative ACD patients was reviewed for early (≤30 days from surgery) complications. Enrollment required at least 1 of the following: cervical kyphosis >10 degrees, cervical scoliosis >10 degrees, C2-7 sagittal vertical axis >4 cm, or chin-brow vertical angle >25 degrees. RESULTS:: Seventy-eight patients underwent surgical treatment for ACD (mean age, 60.8 years). Surgical approaches included anterior-only (14%), posterior-only (49%), anterior-posterior (35%), and posterior-anterior-posterior (3%). Mean numbers of fused anterior and posterior vertebral levels were 4.7 and 9.4, respectively. A total of 52 early complications were reported, including 26 minor and 26 major. Twenty-two (28.2%) patients had at least 1 minor complication, and 19 (24.4%) had at least 1 major complication. Overall, 34 (43.6%) patients had at least 1 complication. The most common complications included dysphagia (11.5%), deep wound infection (6.4%), new C5 motor deficit (6.4%), and respiratory failure (5.1%). One (1.3%) mortality occurred. Early complication rates differed significantly by surgical approach: anterior-only (27.3%), posterior-only (68.4%), and anterior-posterior/posterior-anterior-posterior (79.3%) (P = .007). CONCLUSION:: This report provides benchmark rates for overall and specific ACD surgery complications. Although the surgical approach(es) used were likely driven by the type and complexity of deformity, there were significantly higher complication rates associated with combined and posterior-only approaches compared with anterior-only approaches. These findings may prove useful in treatment planning, patient counseling, and ongoing efforts to improve safety of care. ABBREVIATIONS:: 3CO, 3-column osteotomiesACD, adult cervical deformityEBL, estimated blood lossISSG, International Spine Study groupSVA, sagittal vertical axis

Original languageEnglish (US)
JournalNeurosurgery
DOIs
StateAccepted/In press - Nov 19 2015

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Benchmarking
Chin
Kyphosis
Scoliosis
Wound Infection
Deglutition Disorders
Ambulatory Surgical Procedures
Respiratory Insufficiency
Counseling
Spine
Therapeutics
Databases
Safety
Mortality

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

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Prospective Multicenter Assessment of Early Complication Rates Associated With Adult Cervical Deformity Surgery in 78 Patients. / The International Spine Study Group.

In: Neurosurgery, 19.11.2015.

Research output: Contribution to journalArticle

@article{5768aa85cd9d4342a0dd69b168ad89e9,
title = "Prospective Multicenter Assessment of Early Complication Rates Associated With Adult Cervical Deformity Surgery in 78 Patients",
abstract = "BACKGROUND:: Few reports have focused on treatment of adult cervical deformity (ACD). OBJECTIVE:: To present early complication rates associated with ACD surgery. METHODS:: A prospective multicenter database of consecutive operative ACD patients was reviewed for early (≤30 days from surgery) complications. Enrollment required at least 1 of the following: cervical kyphosis >10 degrees, cervical scoliosis >10 degrees, C2-7 sagittal vertical axis >4 cm, or chin-brow vertical angle >25 degrees. RESULTS:: Seventy-eight patients underwent surgical treatment for ACD (mean age, 60.8 years). Surgical approaches included anterior-only (14{\%}), posterior-only (49{\%}), anterior-posterior (35{\%}), and posterior-anterior-posterior (3{\%}). Mean numbers of fused anterior and posterior vertebral levels were 4.7 and 9.4, respectively. A total of 52 early complications were reported, including 26 minor and 26 major. Twenty-two (28.2{\%}) patients had at least 1 minor complication, and 19 (24.4{\%}) had at least 1 major complication. Overall, 34 (43.6{\%}) patients had at least 1 complication. The most common complications included dysphagia (11.5{\%}), deep wound infection (6.4{\%}), new C5 motor deficit (6.4{\%}), and respiratory failure (5.1{\%}). One (1.3{\%}) mortality occurred. Early complication rates differed significantly by surgical approach: anterior-only (27.3{\%}), posterior-only (68.4{\%}), and anterior-posterior/posterior-anterior-posterior (79.3{\%}) (P = .007). CONCLUSION:: This report provides benchmark rates for overall and specific ACD surgery complications. Although the surgical approach(es) used were likely driven by the type and complexity of deformity, there were significantly higher complication rates associated with combined and posterior-only approaches compared with anterior-only approaches. These findings may prove useful in treatment planning, patient counseling, and ongoing efforts to improve safety of care. ABBREVIATIONS:: 3CO, 3-column osteotomiesACD, adult cervical deformityEBL, estimated blood lossISSG, International Spine Study groupSVA, sagittal vertical axis",
author = "{The International Spine Study Group} and Smith, {Justin S.} and Subaraman Ramchandran and Virginie Lafage and Shaffrey, {Christopher I.} and Tamir Ailon and Eric Klineberg and Themistocles Protopsaltis and Schwab, {Frank J.} and Michael OʼBrien and Richard Hostin and Munish Gupta and Gregory Mundis and Robert Hart and Kim, {Han Jo} and Peter Passias and Scheer, {Justin K.} and Vedat Deviren and Burton, {Douglas C.} and Robert Eastlack and Shay Bess and Albert, {Todd J.} and Riew, {K. D.} and Ames, {Christopher P.}",
year = "2015",
month = "11",
day = "19",
doi = "10.1227/NEU.0000000000001129",
language = "English (US)",
journal = "Neurosurgery",
issn = "0148-396X",
publisher = "Lippincott Williams and Wilkins",

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T1 - Prospective Multicenter Assessment of Early Complication Rates Associated With Adult Cervical Deformity Surgery in 78 Patients

AU - The International Spine Study Group

AU - Smith, Justin S.

AU - Ramchandran, Subaraman

AU - Lafage, Virginie

AU - Shaffrey, Christopher I.

AU - Ailon, Tamir

AU - Klineberg, Eric

AU - Protopsaltis, Themistocles

AU - Schwab, Frank J.

AU - OʼBrien, Michael

AU - Hostin, Richard

AU - Gupta, Munish

AU - Mundis, Gregory

AU - Hart, Robert

AU - Kim, Han Jo

AU - Passias, Peter

AU - Scheer, Justin K.

AU - Deviren, Vedat

AU - Burton, Douglas C.

AU - Eastlack, Robert

AU - Bess, Shay

AU - Albert, Todd J.

AU - Riew, K. D.

AU - Ames, Christopher P.

PY - 2015/11/19

Y1 - 2015/11/19

N2 - BACKGROUND:: Few reports have focused on treatment of adult cervical deformity (ACD). OBJECTIVE:: To present early complication rates associated with ACD surgery. METHODS:: A prospective multicenter database of consecutive operative ACD patients was reviewed for early (≤30 days from surgery) complications. Enrollment required at least 1 of the following: cervical kyphosis >10 degrees, cervical scoliosis >10 degrees, C2-7 sagittal vertical axis >4 cm, or chin-brow vertical angle >25 degrees. RESULTS:: Seventy-eight patients underwent surgical treatment for ACD (mean age, 60.8 years). Surgical approaches included anterior-only (14%), posterior-only (49%), anterior-posterior (35%), and posterior-anterior-posterior (3%). Mean numbers of fused anterior and posterior vertebral levels were 4.7 and 9.4, respectively. A total of 52 early complications were reported, including 26 minor and 26 major. Twenty-two (28.2%) patients had at least 1 minor complication, and 19 (24.4%) had at least 1 major complication. Overall, 34 (43.6%) patients had at least 1 complication. The most common complications included dysphagia (11.5%), deep wound infection (6.4%), new C5 motor deficit (6.4%), and respiratory failure (5.1%). One (1.3%) mortality occurred. Early complication rates differed significantly by surgical approach: anterior-only (27.3%), posterior-only (68.4%), and anterior-posterior/posterior-anterior-posterior (79.3%) (P = .007). CONCLUSION:: This report provides benchmark rates for overall and specific ACD surgery complications. Although the surgical approach(es) used were likely driven by the type and complexity of deformity, there were significantly higher complication rates associated with combined and posterior-only approaches compared with anterior-only approaches. These findings may prove useful in treatment planning, patient counseling, and ongoing efforts to improve safety of care. ABBREVIATIONS:: 3CO, 3-column osteotomiesACD, adult cervical deformityEBL, estimated blood lossISSG, International Spine Study groupSVA, sagittal vertical axis

AB - BACKGROUND:: Few reports have focused on treatment of adult cervical deformity (ACD). OBJECTIVE:: To present early complication rates associated with ACD surgery. METHODS:: A prospective multicenter database of consecutive operative ACD patients was reviewed for early (≤30 days from surgery) complications. Enrollment required at least 1 of the following: cervical kyphosis >10 degrees, cervical scoliosis >10 degrees, C2-7 sagittal vertical axis >4 cm, or chin-brow vertical angle >25 degrees. RESULTS:: Seventy-eight patients underwent surgical treatment for ACD (mean age, 60.8 years). Surgical approaches included anterior-only (14%), posterior-only (49%), anterior-posterior (35%), and posterior-anterior-posterior (3%). Mean numbers of fused anterior and posterior vertebral levels were 4.7 and 9.4, respectively. A total of 52 early complications were reported, including 26 minor and 26 major. Twenty-two (28.2%) patients had at least 1 minor complication, and 19 (24.4%) had at least 1 major complication. Overall, 34 (43.6%) patients had at least 1 complication. The most common complications included dysphagia (11.5%), deep wound infection (6.4%), new C5 motor deficit (6.4%), and respiratory failure (5.1%). One (1.3%) mortality occurred. Early complication rates differed significantly by surgical approach: anterior-only (27.3%), posterior-only (68.4%), and anterior-posterior/posterior-anterior-posterior (79.3%) (P = .007). CONCLUSION:: This report provides benchmark rates for overall and specific ACD surgery complications. Although the surgical approach(es) used were likely driven by the type and complexity of deformity, there were significantly higher complication rates associated with combined and posterior-only approaches compared with anterior-only approaches. These findings may prove useful in treatment planning, patient counseling, and ongoing efforts to improve safety of care. ABBREVIATIONS:: 3CO, 3-column osteotomiesACD, adult cervical deformityEBL, estimated blood lossISSG, International Spine Study groupSVA, sagittal vertical axis

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DO - 10.1227/NEU.0000000000001129

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JO - Neurosurgery

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