Staged posterior surgery for severe adult spinal deformity

Study Design. Retrospective analysis with prospective outcomes. Objective. To analyze the strategy of dividing one prolonged, complex, posterior surgery into two smaller posterior procedures staged during one hospitalization. Summary of Background Data. When operating on complex revision adult deformity, the posterior surgery alone can be unduly prolonged, placing patients at risk for hemodynamic complications associated with protracted same-day surgery. Materials and Methods. Forty-two consecutive adults with severe deformity and 2 years or more of follow-up were included. Thirty-three presented for revision surgery. Twenty-two had more than one previous fusion. During first-stage posterior surgery, existing implants were removed, decompressions performed, and new fixation points established. Five to 7 days later, patients underwent second-stage posterior surgery, consisting of osteotomies (34 patients), completion of instrumentation, and fusion. Anterior surgery was performed during either stage as necessary. Age at surgery was 47 (range 18-68); 4.8 (range 1-9) levels were fused anteriorly and 11.3 (range 4-17) levels posteriorly. Results. No major perioperative medical complications occurred (e.g., myocardial infarction, pulmonary embolus, death). All completed staged surgery as planned. Only five required any postoperative intubation. There was only one perioperative deep infection, one superficial infection, and one sterile seroma. No medical or surgical complication could be related to the staging of posterior surgery. SRS-24 and radiographic outcomes were excellent at ≥2-year follow-up. Conclusion. Staged posterior surgery can be performed safely with few surgical complications and no major medical complications, as well as excellent outcomes in a population known to be at high risk. Such staging can be useful in performing complex posterior revision and osteotomy surgery while limiting hemodynamic stresses.