Does Planned Staging for Posterior-Only Vertebral Column Resections in Spinal Deformity Surgery Increase Perioperative Complications?

Jeffrey L Gum; Lawrence G Lenke; David Bumpass; Johnny Zhao; Patrick Sugrue; Isaac Karikari; Ra'Kerry Rahman; Leah Y Carreon

doi:10.1016/j.jspd.2015.08.005

Does Planned Staging for Posterior-Only Vertebral Column Resections in Spinal Deformity Surgery Increase Perioperative Complications?

Spine Deform. 2016 Mar;4(2):131-137. doi: 10.1016/j.jspd.2015.08.005. Epub 2016 Feb 2.

Authors

Jeffrey L Gum¹, Lawrence G Lenke², David Bumpass², Johnny Zhao², Patrick Sugrue³, Isaac Karikari⁴, Ra'Kerry Rahman⁵, Leah Y Carreon⁶

Affiliations

¹ Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40202, USA.
² Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8233, St. Louis, MO 63110, USA.
³ Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
⁴ Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Box 3807, Durham, NC 27710, USA.
⁵ Orthopedic Group at Springfield Clinic, 800 North 1st Street, 1st Floor, Springfield, IL 62702, USA.
⁶ Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40202, USA. Electronic address: leah.carreon@nortonhealthcare.org.

PMID: 27927545
DOI: 10.1016/j.jspd.2015.08.005

Abstract

Study design: Propensity-matched case control.

Objectives: To compare the perioperative complication rate between single- and two-stage posterior-only VCRs (2-pVCR).

Summary of background data: A vertebral column resection (VCR) for severe spinal deformity is a technically challenging and lengthy procedure with a potentially high complication rate. Planned staging has an advantage of distributing operative time into 2 smaller, more manageable, intervals.

Methods: Adult and pediatric spinal deformity patients undergoing a VCR were retrospectively identified from a single institution's surgical database from 1985 to 2013. Propensity scoring was used to match 2-pVCR and single-staged patients. Each group was matched for 15 preoperative risk factors including demographic, operative, and radiographic characteristics. Perioperative complications were defined as occurring within 2 months of initial surgery. Additionally, a binary logistic regression analysis was performed with complications as the outcome.

Results: A total of 183 consecutive patients were identified as undergoing a VCR, with 172 meeting the inclusion criteria (posterior-only). Forty-four patients underwent planned 2-pVCR whereas 124 had a single-staged VCR. Consistent with propensity-matching, no statistically significant difference between the single- and 2-pVCR cohorts existed for all matching parameters, except pulmonary function tests. There was no significant difference (p = .290) between complication rates for single-stage (12/35; 34%) and 2-pVCR (8/35; 23%) patients. Stepwise binary logistic regression analysis showed that age (p = .014; OR = 0.94, CI = 0.89-0.99) and body mass index (p = .030; OR = 1.13 CI = 1.01-1.26) influenced the occurrence of a complication.

Conclusion: Planned staging of posterior-only VCRs does not increase the occurrence of perioperative complications in adult and pediatric spinal deformity patients.

Level of evidence: III (Propensity-matched case control).

Keywords: Adult deformity; Complications; Staged-surgery; Vertebral column resections.

MeSH terms

Adolescent
Adult
Case-Control Studies
Child
Humans
Kyphosis / surgery*
Neurosurgical Procedures
Operative Time
Orthopedic Procedures*
Scoliosis / surgery*