Combined anterior and posterior fusion in seventy-three spinally deformed patients: indications, results and complications.

Seventy-three patients with complex spinal deformities undergoing combined staged anterior and posterior fusion were analyzed. The indications for the combined approach were (1) severe kyphosis with or without neural compromise; (2) major thoracolumbar or lumbar curves with trunk imbalance or marked pelvic obliquity; (3) severe congenital scoliotic curves associated with hemivertebrae or anterior unsegmented bars; (4) absent posterior elements, e.g., myelodysplasia, post laminectomy; and (5) failed anterior fusion. In 35 patients with kyphosis, the deformity was reduced on the average from 78 degrees to 48 degrees. In 20 patients with marked trunk decompensation and/or pelvic obliquity due to a major thoracolumbar or lumbar curve, the scoliotic deformity was reduced from an average 85 degrees to 33 degrees. In 18 scoliotic patients with marked vertebral body deformation (hemivertebrae, anterior bars, lateral subluxation), the scoliotic curves were reduced from an average 60 degrees to 46 degrees. Postoperative morbidity was not significantly increased because of the combined procedure. The overall complication rate was high (32/73 patients). In view of this high rate of postoperative morbidity, the combined approach should not be undertaken by the occasional spinal surgeon. In selected far advanced or complex spinal deformities, combined anterior and posterior fusion may be indicated to attain optimal correction of the deformity as well as a solid pain-free fusion.