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Prospective Multicenter Assessment of Early Complication Rates Associated With Adult Cervical Deformity Surgery in 78 Patients.

TitleProspective Multicenter Assessment of Early Complication Rates Associated With Adult Cervical Deformity Surgery in 78 Patients.
Publication TypeJournal Article
Year of Publication2016
AuthorsSmith JS, Ramchandran S, Lafage V, Shaffrey CI, Ailon T, Klineberg E, Protopsaltis T, Schwab FJ, OʼBrien M, Hostin R, Gupta M, Mundis G, Hart R, Kim HJo, Passias PG, Scheer JK, Deviren V, Burton DC, Eastlack R, Bess S, Albert TJ, K Riew D, Ames CP
Corporate AuthorsInternational Spine Study Group
JournalNeurosurgery
Volume79
Issue3
Pagination378-88
Date Published2016 Sep
ISSN1524-4040
KeywordsAdult, Databases, Factual, Female, Humans, Kyphosis, Male, Middle Aged, Orthopedic Procedures, Postoperative Complications, Prospective Studies, Scoliosis, Spinal Fusion, Spine
Abstract

BACKGROUND: Few reports have focused on treatment of adult cervical deformity (ACD).

OBJECTIVE: To present early complication rates associated with ACD surgery.

METHODS: A prospective multicenter database of consecutive operative ACD patients was reviewed for early (≤30 days from surgery) complications. Enrollment required at least 1 of the following: cervical kyphosis >10 degrees, cervical scoliosis >10 degrees, C2-7 sagittal vertical axis >4 cm, or chin-brow vertical angle >25 degrees.

RESULTS: Seventy-eight patients underwent surgical treatment for ACD (mean age, 60.8 years). Surgical approaches included anterior-only (14%), posterior-only (49%), anterior-posterior (35%), and posterior-anterior-posterior (3%). Mean numbers of fused anterior and posterior vertebral levels were 4.7 and 9.4, respectively. A total of 52 early complications were reported, including 26 minor and 26 major. Twenty-two (28.2%) patients had at least 1 minor complication, and 19 (24.4%) had at least 1 major complication. Overall, 34 (43.6%) patients had at least 1 complication. The most common complications included dysphagia (11.5%), deep wound infection (6.4%), new C5 motor deficit (6.4%), and respiratory failure (5.1%). One (1.3%) mortality occurred. Early complication rates differed significantly by surgical approach: anterior-only (27.3%), posterior-only (68.4%), and anterior-posterior/posterior-anterior-posterior (79.3%) (P = .007).

CONCLUSION: This report provides benchmark rates for overall and specific ACD surgery complications. Although the surgical approach(es) used were likely driven by the type and complexity of deformity, there were significantly higher complication rates associated with combined and posterior-only approaches compared with anterior-only approaches. These findings may prove useful in treatment planning, patient counseling, and ongoing efforts to improve safety of care.

ABBREVIATIONS: 3CO, 3-column osteotomiesACD, adult cervical deformityEBL, estimated blood lossISSG, International Spine Study groupSVA, sagittal vertical axis.

DOI10.1227/NEU.0000000000001129
Alternate JournalNeurosurgery
PubMed ID26595429