Prospective Multicenter Assessment of All-Cause Mortality Following Surgery for Adult Cervical Deformity.

TitleProspective Multicenter Assessment of All-Cause Mortality Following Surgery for Adult Cervical Deformity.
Publication TypeJournal Article
Year of Publication2018
AuthorsSmith JS, Shaffrey CI, Kim HJo, Passias P, Protopsaltis T, Lafage R, Mundis GM, Klineberg E, Lafage V, Schwab FJ, Scheer JK, Miller E, Kelly M, D Hamilton K, Gupta M, Deviren V, Hostin R, Albert T, K Riew D, Hart R, Burton D, Bess S, Ames CP
Corporate AuthorsInternational Spine Study Group
Date Published2018 12 01
KeywordsAdult, Aged, Cervical Vertebrae, Comorbidity, Female, Humans, Male, Middle Aged, Osteotomy, Prospective Studies, Spinal Curvatures

BACKGROUND: Surgical treatments for adult cervical spinal deformity (ACSD) are often complex and have high complication rates.

OBJECTIVE: To assess all-cause mortality following ACSD surgery.

METHODS: ACSD patients presenting for surgical treatment were identified from a prospectively collected multicenter database. Clinical and surgical parameters and all-cause mortality were assessed.

RESULTS: Of 123 ACSD patients, 120 (98%) had complete baseline data (mean age, 60.6 yr). The mean number of comorbidities per patient was 1.80, and 80% had at least 1 comorbidity. Surgical approaches included anterior only (15.8%), posterior only (50.0%), and combined anterior/posterior (34.2%). The mean number of vertebral levels fused was 8.0 (standard deviation [SD] = 4.5), and 23.3% had a 3-column osteotomy. Death was reported for 11 (9.2%) patients at a mean of 1.1 yr (SD = 0.76 yr; range = 7 d to 2 yr). Mean follow-up for living patients was 1.2 yr (SD = 0.64 yr). Causes of death included myocardial infarction (n = 2), pneumonia/cardiopulmonary failure (n = 2), sepsis (n = 1), obstructive sleep apnea/narcotics (n = 1), subsequently diagnosed amyotrophic lateral sclerosis (n = 1), burn injury related to home supplemental oxygen (n = 1), and unknown (n = 3). Deceased patients did not significantly differ from alive patients based on demographic, clinical, or surgical parameters assessed, except for a higher major complication rate (excluding mortality; 63.6% vs 22.0%, P = .006).

CONCLUSION: All-cause mortality at a mean of 1.2 yr following surgery for ACSD was 9.2% in this prospective multicenter series. Causes of death were reflective of the overall high level of comorbidities. These findings may prove useful for treatment decision making and patient counseling in the context of the substantial impact of ACSD.

Alternate JournalNeurosurgery
PubMed ID29351637