Jeffrey L Gum1, Lawrence G Lenke2, David Bumpass2, Johnny Zhao2, Patrick Sugrue3, Isaac Karikari4, Ra'Kerry Rahman5, Leah Y Carreon6. 1. Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40202, USA. 2. Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8233, St. Louis, MO 63110, USA. 3. Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA. 4. Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Box 3807, Durham, NC 27710, USA. 5. Orthopedic Group at Springfield Clinic, 800 North 1st Street, 1st Floor, Springfield, IL 62702, USA. 6. Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40202, USA. Electronic address: leah.carreon@nortonhealthcare.org.
Abstract
STUDY DESIGN: Propensity-matched case control. OBJECTIVES: To compare the perioperative complication rate between single- and two-stage posterior-only VCRs (2-pVCR). SUMMARY OF BACKGROUND DATA: A vertebral column resection (VCR) for severe spinal deformity is a technically challenging and lengthy procedure with a potentially high complication rate. Planned staging has an advantage of distributing operative time into 2 smaller, more manageable, intervals. METHODS: Adult and pediatric spinal deformity patients undergoing a VCR were retrospectively identified from a single institution's surgical database from 1985 to 2013. Propensity scoring was used to match 2-pVCR and single-staged patients. Each group was matched for 15 preoperative risk factors including demographic, operative, and radiographic characteristics. Perioperative complications were defined as occurring within 2 months of initial surgery. Additionally, a binary logistic regression analysis was performed with complications as the outcome. RESULTS: A total of 183 consecutive patients were identified as undergoing a VCR, with 172 meeting the inclusion criteria (posterior-only). Forty-four patients underwent planned 2-pVCR whereas 124 had a single-staged VCR. Consistent with propensity-matching, no statistically significant difference between the single- and 2-pVCR cohorts existed for all matching parameters, except pulmonary function tests. There was no significant difference (p = .290) between complication rates for single-stage (12/35; 34%) and 2-pVCR (8/35; 23%) patients. Stepwise binary logistic regression analysis showed that age (p = .014; OR = 0.94, CI = 0.89-0.99) and body mass index (p = .030; OR = 1.13 CI = 1.01-1.26) influenced the occurrence of a complication. CONCLUSION: Planned staging of posterior-only VCRs does not increase the occurrence of perioperative complications in adult and pediatric spinal deformity patients. LEVEL OF EVIDENCE: III (Propensity-matched case control).
STUDY DESIGN: Propensity-matched case control. OBJECTIVES: To compare the perioperative complication rate between single- and two-stage posterior-only VCRs (2-pVCR). SUMMARY OF BACKGROUND DATA: A vertebral column resection (VCR) for severe spinal deformity is a technically challenging and lengthy procedure with a potentially high complication rate. Planned staging has an advantage of distributing operative time into 2 smaller, more manageable, intervals. METHODS: Adult and pediatric spinal deformitypatients undergoing a VCR were retrospectively identified from a single institution's surgical database from 1985 to 2013. Propensity scoring was used to match 2-pVCR and single-staged patients. Each group was matched for 15 preoperative risk factors including demographic, operative, and radiographic characteristics. Perioperative complications were defined as occurring within 2 months of initial surgery. Additionally, a binary logistic regression analysis was performed with complications as the outcome. RESULTS: A total of 183 consecutive patients were identified as undergoing a VCR, with 172 meeting the inclusion criteria (posterior-only). Forty-four patients underwent planned 2-pVCR whereas 124 had a single-staged VCR. Consistent with propensity-matching, no statistically significant difference between the single- and 2-pVCR cohorts existed for all matching parameters, except pulmonary function tests. There was no significant difference (p = .290) between complication rates for single-stage (12/35; 34%) and 2-pVCR (8/35; 23%) patients. Stepwise binary logistic regression analysis showed that age (p = .014; OR = 0.94, CI = 0.89-0.99) and body mass index (p = .030; OR = 1.13 CI = 1.01-1.26) influenced the occurrence of a complication. CONCLUSION: Planned staging of posterior-only VCRs does not increase the occurrence of perioperative complications in adult and pediatric spinal deformitypatients. LEVEL OF EVIDENCE: III (Propensity-matched case control).
Authors: Taylor Jackson; Burt Yaszay; Paul D Sponseller; Peter O Newton; Suken A Shah; Firoz Miyanji; Patrick J Cahill Journal: Eur Spine J Date: 2018-08-24 Impact factor: 3.134
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