BACKGROUND: This study aims to describe properties of adult spinal deformity (ASD) revisions relative to primary surgeries and determine clinical variables that can predict revision. ASD is a common pathology that can lead to decreased quality of life, pain, physical limitations, and dissatisfaction with self-image. Durability of interventions for deformity treatment is of paramount concern to surgeons, as revision rates remain high. METHODS: Patients undergoing thoracolumbar fusion, five or more levels, for scoliosis (primary diagnosis ICD-9 737.x) were identified on a state-wide database. Primary and revision (returning for re-fusion procedure) surgeries were compared based on demographic, hospital stay, and clinical characteristics. Differences between primary and revision surgeries, and predictors of primary surgeries requiring revision, utilized binary logistic regression controlling for age, comorbidity burden, and levels fused. RESULTS: A total of 1,063 patients (average 7.4 levels fused, mean age: 47.6 years, 69.0% female) undergoing operative treatment for ASD were identified, of which 123 (average 7.1 levels fused, 11.6%, mean age 61.43, 80.5% female) had surgical revision. Primary surgeries were ~0.3 levels longer (P=0.013), used interbody ~11% more frequently (P=0.020), and used BMP ~12% less frequently (P=0.008). Revisions occurred 176.4 days after the primary on average. The most frequent causes of revisions were: 43.09% implant failure, 24.39% acquired kyphosis, and 14.63% enduring scoliosis. After controlling for age, comorbidities, and levels fused older, more comorbid, female, and white-race patients were more likely to be revised. Upon multivariate regression, after controlling for age and levels fused, overall complications remained non-different (OR: 0.8, 95% CI: 0.6-1.2). However, revision remained an independent predictor for infection (OR: 5.5, 95% CI: 2.8-10.5). CONCLUSIONS: In a statewide database with individual patient follow up of up to 4 years 10% of ASD patients undergoing scoliosis correction required revision. Revision surgeries had higher infection incidence.
BACKGROUND: This study aims to describe properties of adult spinal deformity (ASD) revisions relative to primary surgeries and determine clinical variables that can predict revision. ASD is a common pathology that can lead to decreased quality of life, pain, physical limitations, and dissatisfaction with self-image. Durability of interventions for deformity treatment is of paramount concern to surgeons, as revision rates remain high. METHODS: Patients undergoing thoracolumbar fusion, five or more levels, for scoliosis (primary diagnosis ICD-9 737.x) were identified on a state-wide database. Primary and revision (returning for re-fusion procedure) surgeries were compared based on demographic, hospital stay, and clinical characteristics. Differences between primary and revision surgeries, and predictors of primary surgeries requiring revision, utilized binary logistic regression controlling for age, comorbidity burden, and levels fused. RESULTS: A total of 1,063 patients (average 7.4 levels fused, mean age: 47.6 years, 69.0% female) undergoing operative treatment for ASD were identified, of which 123 (average 7.1 levels fused, 11.6%, mean age 61.43, 80.5% female) had surgical revision. Primary surgeries were ~0.3 levels longer (P=0.013), used interbody ~11% more frequently (P=0.020), and used BMP ~12% less frequently (P=0.008). Revisions occurred 176.4 days after the primary on average. The most frequent causes of revisions were: 43.09% implant failure, 24.39% acquired kyphosis, and 14.63% enduring scoliosis. After controlling for age, comorbidities, and levels fused older, more comorbid, female, and white-race patients were more likely to be revised. Upon multivariate regression, after controlling for age and levels fused, overall complications remained non-different (OR: 0.8, 95% CI: 0.6-1.2). However, revision remained an independent predictor for infection (OR: 5.5, 95% CI: 2.8-10.5). CONCLUSIONS: In a statewide database with individual patient follow up of up to 4 years 10% of ASD patients undergoing scoliosis correction required revision. Revision surgeries had higher infection incidence.
Authors: Shian Liu; Frank Schwab; Justin S Smith; Eric Klineberg; Christopher P Ames; Gregory Mundis; Richard Hostin; Khaled Kebaish; Vedat Deviren; Munish Gupta; Oheneba Boachie-Adjei; Robert A Hart; Shay Bess; Virginie Lafage Journal: Ochsner J Date: 2014
Authors: Dennis W Hallager; Sven Karstensen; Naeem Bukhari; Martin Gehrchen; Benny Dahl Journal: Spine (Phila Pa 1976) Date: 2017-07-15 Impact factor: 3.468
Authors: Varun Puvanesarajah; Francis H Shen; Jourdan M Cancienne; Wendy M Novicoff; Amit Jain; Adam L Shimer; Hamid Hassanzadeh Journal: J Neurosurg Spine Date: 2016-05-06
Authors: Justin K Scheer; Virginie Lafage; Justin S Smith; Vedat Deviren; Richard Hostin; Ian M McCarthy; Gregory M Mundis; Douglas C Burton; Eric Klineberg; Munish Gupta; Khaled Kebaish; Christopher I Shaffrey; Shay Bess; Frank Schwab; Christopher P Ames Journal: Eur Spine J Date: 2014-06-01 Impact factor: 3.134
Authors: Shay Bess; Breton Line; Kai-Ming Fu; Ian McCarthy; Virgine Lafage; Frank Schwab; Christopher Shaffrey; Christopher Ames; Behrooz Akbarnia; Han Jo; Michael Kelly; Douglas Burton; Robert Hart; Eric Klineberg; Khaled Kebaish; Richard Hostin; Gregory Mundis; Praveen Mummaneni; Justin S Smith Journal: Spine (Phila Pa 1976) Date: 2016-02 Impact factor: 3.468