Oral Posters: Adult Spinal Deformity
Presented by: I. Lieberman - View Audio/Video Presentation (Members Only)
S. Farhan(1), M. Eichler(1), X. Hu(2), I. Lieberman(2), T. Belanger(3), A. Pendi(1), S. Bederman(4)
(1) University of California Irvine, Irvine, CA, United States
(2) Texas Back Institute, Texas Health Presbyterian Hospital Plano, Scoliosis and Spine Tumor Center, Plano, TX, United States
(3) Texas Back Institute, Plano, TX, United States
(4) Restore Orthopedics & Spine Center, Orange, CA, United States
Introduction: Revision surgeries are performed in 9% to 19% of adult patients who have undergone spine deformity surgery and these surgeries are technically more challenging. However, few studies have studied the impact of previous operations on patients' outcome after revision adult spinal deformity (ASD) surgery. The purpose of this study is to review a series of consecutive revision ASD surgeries and to study the effect of the number of previous operations on patients' outcome.
Methods: Data were retrospectively collected from 137 consecutive patients who underwent revision ASD surgeries by a single surgeon between 2010 and 2013. The patients were classified into three groups: patients who had one previous operation (group 1), patients who had two previous operations (group 2), and patients who had 3 or more previous operations (group 3). Peri-operative surgical and medical complications up to 90 days post-op and additional surgeries up to the latest follow-up were reviewed. Back pain VAS, leg pain VAS, ODI scores and radiographic measurements were obtained preoperatively and at the latest follow-up visit.
Results: There were 51 patients in group 1, 45 patients in group 2 and 41 patients in group 3. The patients' gender, age, BMI and follow-up intervals were not different among the groups (p>0.05). Pre-operatively, the patients' back pain and arm pain VAS scores were not statistically different (p>0.05). However, the patients in group 3 had significantly worse ODI scores (60.0, comparing with 48.1 in group 1 and 47.9 in group 2, p< 0.01). The patients in group 2 and group 3 had significantly worse Plumb line (p< 0.05) and SVA (p< 0.05). The patients in group 3 had relatively worse PI-LL mismatch (p=0.08). Minor and major peri-operative surgical and medical complications occurred in 14 patients (27.5%) in group 1, 14 patients (31.1%) in group 2 and 16 patients (39.0%) in group 3 (p>0.05). At mean 30 months follow-up, 4 patients in group 1 (7.8%), 8 patients in group 2 (17.8%) and 9 patients in group 3 (22.0%) had additional surgeries (p=0.07). In group 1, the patients' back pain improved 2.6 points (6.5 vs 3.9, p< 0.01), leg pain improved 2.9 points (4.8 vs 1.9, p< 0.01), ODI scores improved 15.0 points (47.9 vs 32.9, p< 0.01). In group 2, the patients' back pain improved 2.5 points (7.1 vs 4.6, p< 0.01), leg pain improved 2.2 points (5.4 vs 3.2, p< 0.01), ODI scores improved 8.3 points (48.1 vs 39.8, p=0.10). In group 3, the patients' back pain improved 2.1 points (7.2 vs 5.1, p< 0.01), leg pain improved 1.8 points (5.6 vs 3.8, p=0.08), ODI scores improved 18.0 points (63.4 vs 45.4, p< 0.01). The net improvements on back pain, leg pain and ODI scores were not statistically different among the groups (p>0.05).
Conclusion: Revision ASD patients who had two or more previous operations are presenting with more coronal and sagittal imbalance and worse functional status. Patients who had three or more previous operations have relatively higher reoperation rate but similar peri-operative complication rate and similar clinic improvements at mean 30 months follow-up.