Yu Yamato1, Yukihiro Matsuyama2, Kazuhiro Hasegawa3, Yoichi Aota4, Tsutomu Akazawa5, Takahiro Iida6, Kazumasa Ueyama7, Koki Uno8, Tokumi Kanemura9, Noriaki Kawakami10, Toshiaki Kotani5, Masashi Takaso11, Jun Takahashi12, Masato Tanaka13, Hiroshi Taneichi14, Taichi Tsuji10, Hideo Hosoe15, Joji Mochida16, Takachika Shimizu17, Ikuho Yonezawa18, Kota Watanabe19, Morio Matsumoto19. 1. Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Handayama 1-20-1, Higashi-ku, Hamamatsu-shi 431-3192, Shizuoka, Japan. Electronic address: yamato@hama-med.ac.jp. 2. Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Handayama 1-20-1, Higashi-ku, Hamamatsu-shi 431-3192, Shizuoka, Japan. 3. Niigata Spine Surgery Center, Nishimachi 2-5-22, Konan-ku, Niigata-shi 950-0165, Japan. 4. Department of Spinal Surgery, Yokohama Brain and Spine Center, Takigashira 1-2-1, Isogo-ku, Yokohama-shi 235-0012, Japan. 5. Department of Orthopaedic Surgery, Seirei Sakura Citizen Hospital, Ebaradai 2-36-2, Sakura-shi 285-8765, Japan. 6. Department of Orthopaedic Surgery, Dokkyo Medical University Koshigaya Hospital, Minamikoshigaya 2-1-50, Koshigaya-shi 343-8555, Japan. 7. Department of Orthopaedic Surgery, Hirosaki Memorial Hospital, Sakaizekinishita 59-1, Hirosaki-shi 036-8076, Japan. 8. Department of Orthopaedic Surgery, National Hospital Organization Kobe Medical Center, Nishiochiai 3-1-1, Suma-ku, Kobe-shi 654-0155, Japan. 9. Department of Orthopaedic Surgery, Konan Kosei Hospital, Takayacho Omatsubara 137, Konan-shi 483-8704, Japan. 10. Department of Orthopaedic Surgery, Meijo Hospital, Sannomaru 1-3-1, Naka-ku, Nagoya-shi 460-0001, Japan. 11. Department of Orthopaedic Surgery, Kitasato University School of Medicine, Kitasato 1-15-1, Minami-ku, Sagamihara-shi 252-0375, Japan. 12. Department of Orthopaedic Surgery, Shinshu University, Asahi 3-1-1, Matsumoto-shi, 390-8621, Japan. 13. Department of Orthopaedic Surgery, Okayama University Hospital, Shikatacho 2-5-1, Okayama-shi 700-8558, Japan. 14. Department of Orthopaedic Surgery, Dokkyo Medical University, Kitakobayashi 880, Mibumachi, Shimotsuga-gun, 321-0207, Japan. 15. Department of Orthopaedic Surgery, Gifu Prefectural General Medical Center, Noisshiki 4-6-1, Gifu-shi 500-8717, Japan. 16. Department of Orthopaedic Surgery, Tokai University School of Medicine, Shimokasuya 143, Isehara-shi 259-1193, Japan. 17. Department of Orthopaedic Surgery, Gunma Spine Center, Kamitoyookamachi 828-1, Takasaki-shi 370-0871, Japan. 18. Department of Orthopaedic Surgery, Juntendo University School of Medicine, Hongo 3-1-3, Bunkyou-ku, Tokyo 113-8431, Japan. 19. Department of Orthopaedic Surgery, Keio University, Shinanomachi 35, Shinjuku-ku, 160-8582, Japan.
Abstract
BACKGROUND: Recently, corrective fusion surgery for patients with adult spinal deformity (ASD) has become common in Japan. This study aimed to clarify the status of surgeries for ASD in Japan, focusing on perioperative complications. A nationwide multicenter survey gathering information on surgically treated ASD patients was conducted by the committee for Adult Spinal Deformity of the Japanese Scoliosis Society. METHODS: This study was a review of retrospectively collected data from 18 spine scoliosis centers belonging to the Japanese Scoliosis Society. Patients who underwent corrective fusion surgery for ASD between 2011 and 2013 were included. Demographics, comorbidities, surgical data, and complications were investigated. RESULTS: A total of 1192 patients (mean age, 57.7 years) were included in this study. Of these, 611 patients were aged less than 65 years and 581 patients were aged 65 years or greater. The age distribution had two peaks, in the third and eighth decades. Deformities caused by degeneration represented 67% of the pathology in patients aged over 65 years; however, non-degenerative disease such as adult idiopathic scoliosis and syndromic or congenital deformity represented over 60% of pathology in patients aged less than 65 years. The iatrogenic deformity and reoperation rates were both less than 3%. The mean operation time and estimated blood loss were 370 min and 1642 ml, respectively. Major perioperative complications occurred in 160 patients (14.5%). The incidence of complications was significantly higher in patients aged over 65 years, including neurological deficits, hemorrhagic shock, hematoma, heart failure, and surgical site infection (p < 0.05). CONCLUSIONS: Older (aged over 65 years) ASD patients showed greater rates of deformity due to the occurrence of degeneration and vertebral fractures, as well as a higher incidence of peri-and postoperative complications. Efforts to reduce perioperative complications are therefore imperative, especially for elderly ASD patients in our aging society.
BACKGROUND: Recently, corrective fusion surgery for patients with adult spinal deformity (ASD) has become common in Japan. This study aimed to clarify the status of surgeries for ASD in Japan, focusing on perioperative complications. A nationwide multicenter survey gathering information on surgically treated ASDpatients was conducted by the committee for Adult Spinal Deformity of the Japanese Scoliosis Society. METHODS: This study was a review of retrospectively collected data from 18 spine scoliosis centers belonging to the Japanese Scoliosis Society. Patients who underwent corrective fusion surgery for ASD between 2011 and 2013 were included. Demographics, comorbidities, surgical data, and complications were investigated. RESULTS: A total of 1192 patients (mean age, 57.7 years) were included in this study. Of these, 611 patients were aged less than 65 years and 581 patients were aged 65 years or greater. The age distribution had two peaks, in the third and eighth decades. Deformities caused by degeneration represented 67% of the pathology in patients aged over 65 years; however, non-degenerative disease such as adult idiopathic scoliosis and syndromic or congenital deformity represented over 60% of pathology in patients aged less than 65 years. The iatrogenic deformity and reoperation rates were both less than 3%. The mean operation time and estimated blood loss were 370 min and 1642 ml, respectively. Major perioperative complications occurred in 160 patients (14.5%). The incidence of complications was significantly higher in patients aged over 65 years, including neurological deficits, hemorrhagic shock, hematoma, heart failure, and surgical site infection (p < 0.05). CONCLUSIONS: Older (aged over 65 years) ASDpatients showed greater rates of deformity due to the occurrence of degeneration and vertebral fractures, as well as a higher incidence of peri-and postoperative complications. Efforts to reduce perioperative complications are therefore imperative, especially for elderly ASDpatients in our aging society.