Aladine A Elsamadicy1, Owoicho Adogwa2, Shay Behrens1, Amanda Sergesketter1, Angel Chen1, Ankit I Mehta3, Raul A Vasquez4, Joseph Cheng5, Carlos A Bagley6, Isaac O Karikari1. 1. Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA. 2. Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA. 3. Department of Neurosurgery, The University of Illinois at Chicago, Chicago, IL, USA. 4. Department of Neurosurgery, University of Kentucky, Lexington, KY, USA. 5. Department of Neurosurgery, Yale University, New Haven, CT, USA. 6. Department of Neurosurgery, University of Texas Southwestern, Dallas, TX, USA.
Abstract
BACKGROUND: While there are variations in techniques and surgical approaches to spinal fusion, there is not a defined consensus on a recommended surgical approach. The aim of this study is to determine if there was a difference in intra- and post-operative complication rates between different surgical approaches after elective spinal fusion (≥3 levels) for adult spine deformity. METHODS: The medical records of 443 adult spine deformity patients undergoing elective spinal fusion (≥3) at a major academic institution from 2005 to 2015 were reviewed. We identified 96 (21.7%) anterior only, 225 (50.8%) posterior only, and 122 (27.5%) combined anterior/posterior approaches taken for spinal fusion (anterior: n=96; posterior: n=225). Patient demographics, comorbidities, anatomical location, and complication rates were collected for each patient. The primary outcome investigated in this study was the rate of intra- and post-operative complications. RESULTS: Patient demographics and comorbidities were similar between all groups. The posterior approach had significantly higher EBL (P<0.0001) and number of PRBC blood transfusions (P<0.002), while the combined approach had a higher operative time (P<0.0001). The posterior approach had a significantly higher rate of intraoperative durotomies than anterior and combined (anterior: 0% vs. posterior: 11.1% vs. combined: 4.1%, P<0.0001). There was no significant difference in the rate 30-day readmissions between the cohorts (anterior: 10.4% vs. posterior: 12.8% vs. combined: 13.1%, P=0.80). CONCLUSIONS: Our study suggests that posterior approaches to spinal fusion may lead to a higher incidence of complications compared to anterior or combined anterior/posterior approaches.
BACKGROUND: While there are variations in techniques and surgical approaches to spinal fusion, there is not a defined consensus on a recommended surgical approach. The aim of this study is to determine if there was a difference in intra- and post-operative complication rates between different surgical approaches after elective spinal fusion (≥3 levels) for adult spine deformity. METHODS: The medical records of 443 adult spine deformitypatients undergoing elective spinal fusion (≥3) at a major academic institution from 2005 to 2015 were reviewed. We identified 96 (21.7%) anterior only, 225 (50.8%) posterior only, and 122 (27.5%) combined anterior/posterior approaches taken for spinal fusion (anterior: n=96; posterior: n=225). Patient demographics, comorbidities, anatomical location, and complication rates were collected for each patient. The primary outcome investigated in this study was the rate of intra- and post-operative complications. RESULTS:Patient demographics and comorbidities were similar between all groups. The posterior approach had significantly higher EBL (P<0.0001) and number of PRBC blood transfusions (P<0.002), while the combined approach had a higher operative time (P<0.0001). The posterior approach had a significantly higher rate of intraoperative durotomies than anterior and combined (anterior: 0% vs. posterior: 11.1% vs. combined: 4.1%, P<0.0001). There was no significant difference in the rate 30-day readmissions between the cohorts (anterior: 10.4% vs. posterior: 12.8% vs. combined: 13.1%, P=0.80). CONCLUSIONS: Our study suggests that posterior approaches to spinal fusion may lead to a higher incidence of complications compared to anterior or combined anterior/posterior approaches.
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