Abstract
Study Design: Retrospective review of a prospectively collected multicenter database. Objectives: To evaluate the evolution of surgical treatment strategies, complications, and patient-reported outcomes for adult spinal deformity (ASD) patients. Summary of Background Data: ASD surgery is associated with high complication rates. Evolving treatment strategies may reduce these risks. Methods: Adult patients undergoing ASD surgery from 2009 to 2016 were analyzed (n = 905). Preoperative and surgical parameters were compared across years. Subgroup analysis of 436 patients with minimum two-year follow-up was also performed. Results: From 2009 to 2016, there was a significant increase in the mean preoperative age (52 to 63.1, p < .001), body mass index (26.3 to 32.2, p = .003), Charlson Comorbidity index (1.4 to 2.2, p < .001), rate of previous spine surgery (39.8% to 53.1%, p = .01), and baseline disability (visual analog scale [VAS] back and leg pain) scores (p < .01), Oswestry Disability Index, and 22-item Scoliosis Research Society Questionnaire scores (p < .001). Preoperative Schwab sagittal alignment modifiers and overall surgical invasiveness index were similar across time. Three-column osteotomy utilization decreased from 36% in 2011 to 16.7% in 2016. Lateral lumbar interbody fusion increased from 6.4% to 24.1% (p = .004), anterior lumbar interbody fusion decreased from 22.9% to 16.7% (p = .043), and transforaminal lumbar interbody fusion/posterior lumbar interbody fusion utilization remained similar (p = .448). Use of recombinant human bone morphogenetic protein-2 (rhBMP-2) in 2012 was 84.6%, declined to 58% in 2013, and rebounded to 76.3% in 2016 (p = .006). Tranexamic acid use increased rapidly from 2009 to 2016 (13.3% to 48.6%, p < .001). Two-year follow-up sagittal vertical axis, pelvic tilt, pelvic incidence–lumbar lordosis, and maximum Cobb angles were similar across years. Intraoperative complications decreased from 33% in 2010 to 9.3% in 2016 (p < .001). Perioperative (<30 days, <90 days) complications peaked in 2010 (42.7%, 46%) and decreased by 2016 (24.1%, p < .001; 29.6%, p = .007). The overall complication rate decreased from 73.2% in 2008–2014 patients to 62.6% in 2015–2016 patients (p = .03). Two-year health-related quality of life outcomes did not significantly differ across the years (p > .05). Conclusions: From 2009 to 2016, despite an increasingly elderly, medically compromised, and obese patient population, complication rates decreased. Evolving strategies may result in improved treatment of ASD patients. Level of Evidence: Level IV.
| Original language | English |
|---|---|
| Pages (from-to) | 481-488 |
| Number of pages | 8 |
| Journal | Spine deformity |
| Volume | 7 |
| Issue number | 3 |
| DOIs | |
| State | Published - May 2019 |
Keywords
- ASD
- Adult spinal deformity
- Complications
- Health-related quality of life
- Three-column osteotomy
Fingerprint
Dive into the research topics of 'Evolution in Surgical Approach, Complications, and Outcomes in an Adult Spinal Deformity Surgery Multicenter Study Group Patient Population'. Together they form a unique fingerprint.Cite this
- APA
- Author
- BIBTEX
- Harvard
- Standard
- RIS
- Vancouver
}
In: Spine deformity, Vol. 7, No. 3, 05.2019, p. 481-488.
Research output: Contribution to journal › Article › peer-review
TY - JOUR
T1 - Evolution in Surgical Approach, Complications, and Outcomes in an Adult Spinal Deformity Surgery Multicenter Study Group Patient Population
AU - International Spine Study Group
AU - Daniels, Alan H.
AU - Reid, Daniel B.C.
AU - Tran, Stacie Nguyen
AU - Hart, Robert A.
AU - Klineberg, Eric O.
AU - Bess, Shay
AU - Burton, Douglas
AU - Smith, Justin S.
AU - Shaffrey, Christopher
AU - Gupta, Munish
AU - Ames, Christopher P.
AU - Hamilton, D. Kojo
AU - LaFage, Virginie
AU - Schwab, Frank
AU - Eastlack, Robert
AU - Akbarnia, Behrooz
AU - Kim, Han Jo
AU - Kelly, Michael
AU - Passias, Peter G.
AU - Protopsaltis, Themistocles
AU - Mundis, Gregory M.
N1 - Funding Information: This study was funded by the International Spine Study Group Foundation (ISSGF). Funding Information: Author disclosures: AHD (grants and personal fees from Orthofix; personal fees from Stryker and SpineArt; other from Springer, outside the submitted work), DBCR (none), SNT (none), RAH (other from American Orthopaedic Association; other from Cervical Spine Research Society [CSRS]; personal fees and other from DePuy, Globus Medical, SeaSpine, and ISSLS Textbook of the Lumbar Spine; personal fees from Medtronic; grants from Misonix; other from North America Spine Society, personal fees from Orthofix, Inc.; other from Scoliosis Research Society, Western Ortho Association, and International Spine Study Group [ISSG], outside the submitted work; in addition, RAH has a patent DePuy with royalties paid, a patent Globus Medical with royalties paid, and a patent SeaSpine with royalties paid), EOK (grants and personal fees from AO Spine and DePuy; grants from OREF; personal fees from K2M, Springer, Stryker, and Trevena, outside the submitted work), SB (grants from DePuy Synthes, during the conduct of the study; grants and personal fees from K2 Medical; personal fees from Pioneer and Allosource; grants from DePuy Synthes, Medtronic, and NuVasive, outside the submitted work), DB (grants from Bioventis; personal fees and other from DePuy; grants from Pfizer; other from Scoliosis Research Society and Spine Deformity, outside the submitted work; in addition, SB has a patent DePuy with royalties paid), JSS (grants from DePuy Synthes/ISSG, during the conduct of the study; personal fees from Zimmer Biomet, NuVasive, K2M, and Allosource; grants from DePuy Synthes/ISSG, Neurosurgery Research and Education Foundation, and AOSpine, outside the submitted work), CS (other from American Association of Neurological Surgeons and American Board of Neurological Surgery; personal fees from Biomet; other from CSRS; grants from DePuy; personal fees from K2M and Medtronic; personal fees and other from Medtronic Sofamor Danek and NuVasive; other from Scoliosis Research Society, Spinal Deformity, and Spine; personal fees from Stryker and Zimmer, outside the submitted work; in addition, CS has a patent Zimmer with royalties paid), MG (personal fees and other from DePuy; other from European Spine Journal, Global Spine Journal, Johnson & Johnson, Proctor and Gamble, and Spine Deformity, outside the submitted work), CPA (grants and personal fees from NuVasive; personal fees from K2M, DePuy Synthes, and NociMed; grants from SeaSpine, outside the submitted work), DKH (none), VLF (grants and personal fees from DePuy; other from ISSG; personal fees from Medtronic, other from Nemaris INC and Scoliosis Research Society, outside the submitted work), FS (grants from DePuy; personal fees and other from K2M; personal fees from Medicrea, NuVasive, and Medtronic; other from Medtronic Sofamor Danek, Nemaris, Scoliosis Research Society, Spine Deformity, and ISSG; personal fees and other from Zimmer, outside the submitted work; in addition, FS has a patent K2M with royalties paid, a patent Medtronic Sofamor Danek with royalties paid, and a patent Zimmer with royalties paid), RE (other from Alphatec; grants, personal fees, nonfinancial support, and other from NuVasive; personal fees from Globus Medical and K2M; personal fees and nonfinancial support from SeaSpine; personal fees from Titan and SI Bone; other from Spine Innovation and NuTech, personal fees from Eli Lilly, outside the submitted work), BA (grants and personal fees from NuVasive; personal fees from K2M, DePuy Synthes, and NociMed; grants from SeaSpine, outside the submitted work), HJK (other from AO spine, ISSG Foundation, Scoliosis Research Society, HSS Journal, and Asian Spine Journal; personal fees from K2M and Zimmer Biomet, outside the submitted work), MK (grants from DePuy Synthes Spine, outside the submitted work), PGP (grants from DePuy Synthes, during the conduct of the study; personal fees from Medicrea, SpineWave, Zimmer Biomet, Globus, Allosource, and Aesculap; grants from CSRS, outside the submitted work), TP (grants from CSRS; personal fees from Globus Medical, Innovasis, Medicrea International, and NuVasive; grants from Zimmer, outside the submitted work), GMM (personal fees from DePuy; other from ISSG Foundation and K2M; grants, personal fees, and other from NuVasive, outside the submitted work; in addition, GMM has a patent K2M with royalties paid), ISSG (grants from DePuy Synthes Spine, K2M, NuVasive, Biomet, and Orthofix, during the conduct of the study; grants from Medtronic and Stryker, outside the submitted work). Funding Information: Author disclosures: AHD (grants and personal fees from Orthofix; personal fees from Stryker and SpineArt; other from Springer, outside the submitted work), DBCR (none), SNT (none), RAH (other from American Orthopaedic Association; other from Cervical Spine Research Society [CSRS]; personal fees and other from DePuy, Globus Medical, SeaSpine, and ISSLS Textbook of the Lumbar Spine; personal fees from Medtronic; grants from Misonix; other from North America Spine Society, personal fees from Orthofix, Inc.; other from Scoliosis Research Society, Western Ortho Association, and International Spine Study Group [ISSG], outside the submitted work; in addition, RAH has a patent DePuy with royalties paid, a patent Globus Medical with royalties paid, and a patent SeaSpine with royalties paid), EOK (grants and personal fees from AO Spine and DePuy; grants from OREF; personal fees from K2M, Springer, Stryker, and Trevena, outside the submitted work), SB (grants from DePuy Synthes, during the conduct of the study; grants and personal fees from K2 Medical; personal fees from Pioneer and Allosource; grants from DePuy Synthes, Medtronic, and NuVasive, outside the submitted work), DB (grants from Bioventis; personal fees and other from DePuy; grants from Pfizer; other from Scoliosis Research Society and Spine Deformity, outside the submitted work; in addition, SB has a patent DePuy with royalties paid), JSS (grants from DePuy Synthes/ISSG, during the conduct of the study; personal fees from Zimmer Biomet, NuVasive, K2M, and Allosource; grants from DePuy Synthes/ISSG, Neurosurgery Research and Education Foundation, and AOSpine, outside the submitted work), CS (other from American Association of Neurological Surgeons and American Board of Neurological Surgery; personal fees from Biomet; other from CSRS; grants from DePuy; personal fees from K2M and Medtronic; personal fees and other from Medtronic Sofamor Danek and NuVasive; other from Scoliosis Research Society, Spinal Deformity, and Spine; personal fees from Stryker and Zimmer, outside the submitted work; in addition, CS has a patent Zimmer with royalties paid), MG (personal fees and other from DePuy; other from European Spine Journal, Global Spine Journal, Johnson & Johnson, Proctor and Gamble, and Spine Deformity, outside the submitted work), CPA (grants and personal fees from NuVasive; personal fees from K2M, DePuy Synthes, and NociMed; grants from SeaSpine, outside the submitted work), DKH (none), VLF (grants and personal fees from DePuy; other from ISSG; personal fees from Medtronic, other from Nemaris INC and Scoliosis Research Society, outside the submitted work), FS (grants from DePuy; personal fees and other from K2M; personal fees from Medicrea, NuVasive, and Medtronic; other from Medtronic Sofamor Danek, Nemaris, Scoliosis Research Society, Spine Deformity, and ISSG; personal fees and other from Zimmer, outside the submitted work; in addition, FS has a patent K2M with royalties paid, a patent Medtronic Sofamor Danek with royalties paid, and a patent Zimmer with royalties paid), RE (other from Alphatec; grants, personal fees, nonfinancial support, and other from NuVasive; personal fees from Globus Medical and K2M; personal fees and nonfinancial support from SeaSpine; personal fees from Titan and SI Bone; other from Spine Innovation and NuTech, personal fees from Eli Lilly, outside the submitted work), BA (grants and personal fees from NuVasive; personal fees from K2M, DePuy Synthes, and NociMed; grants from SeaSpine, outside the submitted work), HJK (other from AO spine, ISSG Foundation, Scoliosis Research Society, HSS Journal, and Asian Spine Journal; personal fees from K2M and Zimmer Biomet, outside the submitted work), MK (grants from DePuy Synthes Spine, outside the submitted work), PGP (grants from DePuy Synthes, during the conduct of the study; personal fees from Medicrea, SpineWave, Zimmer Biomet, Globus, Allosource, and Aesculap; grants from CSRS, outside the submitted work), TP (grants from CSRS; personal fees from Globus Medical, Innovasis, Medicrea International, and NuVasive; grants from Zimmer, outside the submitted work), GMM (personal fees from DePuy; other from ISSG Foundation and K2M; grants, personal fees, and other from NuVasive, outside the submitted work; in addition, GMM has a patent K2M with royalties paid), ISSG (grants from DePuy Synthes Spine, K2M, NuVasive, Biomet, and Orthofix, during the conduct of the study; grants from Medtronic and Stryker, outside the submitted work). This study was funded by the International Spine Study Group Foundation (ISSGF). Publisher Copyright: © 2018 Scoliosis Research Society
PY - 2019/5
Y1 - 2019/5
N2 - Study Design: Retrospective review of a prospectively collected multicenter database. Objectives: To evaluate the evolution of surgical treatment strategies, complications, and patient-reported outcomes for adult spinal deformity (ASD) patients. Summary of Background Data: ASD surgery is associated with high complication rates. Evolving treatment strategies may reduce these risks. Methods: Adult patients undergoing ASD surgery from 2009 to 2016 were analyzed (n = 905). Preoperative and surgical parameters were compared across years. Subgroup analysis of 436 patients with minimum two-year follow-up was also performed. Results: From 2009 to 2016, there was a significant increase in the mean preoperative age (52 to 63.1, p < .001), body mass index (26.3 to 32.2, p = .003), Charlson Comorbidity index (1.4 to 2.2, p < .001), rate of previous spine surgery (39.8% to 53.1%, p = .01), and baseline disability (visual analog scale [VAS] back and leg pain) scores (p < .01), Oswestry Disability Index, and 22-item Scoliosis Research Society Questionnaire scores (p < .001). Preoperative Schwab sagittal alignment modifiers and overall surgical invasiveness index were similar across time. Three-column osteotomy utilization decreased from 36% in 2011 to 16.7% in 2016. Lateral lumbar interbody fusion increased from 6.4% to 24.1% (p = .004), anterior lumbar interbody fusion decreased from 22.9% to 16.7% (p = .043), and transforaminal lumbar interbody fusion/posterior lumbar interbody fusion utilization remained similar (p = .448). Use of recombinant human bone morphogenetic protein-2 (rhBMP-2) in 2012 was 84.6%, declined to 58% in 2013, and rebounded to 76.3% in 2016 (p = .006). Tranexamic acid use increased rapidly from 2009 to 2016 (13.3% to 48.6%, p < .001). Two-year follow-up sagittal vertical axis, pelvic tilt, pelvic incidence–lumbar lordosis, and maximum Cobb angles were similar across years. Intraoperative complications decreased from 33% in 2010 to 9.3% in 2016 (p < .001). Perioperative (<30 days, <90 days) complications peaked in 2010 (42.7%, 46%) and decreased by 2016 (24.1%, p < .001; 29.6%, p = .007). The overall complication rate decreased from 73.2% in 2008–2014 patients to 62.6% in 2015–2016 patients (p = .03). Two-year health-related quality of life outcomes did not significantly differ across the years (p > .05). Conclusions: From 2009 to 2016, despite an increasingly elderly, medically compromised, and obese patient population, complication rates decreased. Evolving strategies may result in improved treatment of ASD patients. Level of Evidence: Level IV.
AB - Study Design: Retrospective review of a prospectively collected multicenter database. Objectives: To evaluate the evolution of surgical treatment strategies, complications, and patient-reported outcomes for adult spinal deformity (ASD) patients. Summary of Background Data: ASD surgery is associated with high complication rates. Evolving treatment strategies may reduce these risks. Methods: Adult patients undergoing ASD surgery from 2009 to 2016 were analyzed (n = 905). Preoperative and surgical parameters were compared across years. Subgroup analysis of 436 patients with minimum two-year follow-up was also performed. Results: From 2009 to 2016, there was a significant increase in the mean preoperative age (52 to 63.1, p < .001), body mass index (26.3 to 32.2, p = .003), Charlson Comorbidity index (1.4 to 2.2, p < .001), rate of previous spine surgery (39.8% to 53.1%, p = .01), and baseline disability (visual analog scale [VAS] back and leg pain) scores (p < .01), Oswestry Disability Index, and 22-item Scoliosis Research Society Questionnaire scores (p < .001). Preoperative Schwab sagittal alignment modifiers and overall surgical invasiveness index were similar across time. Three-column osteotomy utilization decreased from 36% in 2011 to 16.7% in 2016. Lateral lumbar interbody fusion increased from 6.4% to 24.1% (p = .004), anterior lumbar interbody fusion decreased from 22.9% to 16.7% (p = .043), and transforaminal lumbar interbody fusion/posterior lumbar interbody fusion utilization remained similar (p = .448). Use of recombinant human bone morphogenetic protein-2 (rhBMP-2) in 2012 was 84.6%, declined to 58% in 2013, and rebounded to 76.3% in 2016 (p = .006). Tranexamic acid use increased rapidly from 2009 to 2016 (13.3% to 48.6%, p < .001). Two-year follow-up sagittal vertical axis, pelvic tilt, pelvic incidence–lumbar lordosis, and maximum Cobb angles were similar across years. Intraoperative complications decreased from 33% in 2010 to 9.3% in 2016 (p < .001). Perioperative (<30 days, <90 days) complications peaked in 2010 (42.7%, 46%) and decreased by 2016 (24.1%, p < .001; 29.6%, p = .007). The overall complication rate decreased from 73.2% in 2008–2014 patients to 62.6% in 2015–2016 patients (p = .03). Two-year health-related quality of life outcomes did not significantly differ across the years (p > .05). Conclusions: From 2009 to 2016, despite an increasingly elderly, medically compromised, and obese patient population, complication rates decreased. Evolving strategies may result in improved treatment of ASD patients. Level of Evidence: Level IV.
KW - ASD
KW - Adult spinal deformity
KW - Complications
KW - Health-related quality of life
KW - Three-column osteotomy
UR - http://www.scopus.com/inward/record.url?scp=85055868023&partnerID=8YFLogxK
U2 - 10.1016/j.jspd.2018.09.013
DO - 10.1016/j.jspd.2018.09.013
M3 - Article
C2 - 31053319
AN - SCOPUS:85055868023
SN - 2212-134X
VL - 7
SP - 481
EP - 488
JO - Spine Deformity
JF - Spine Deformity
IS - 3
ER -