Lightning Podiums: Adult Spinal Deformity - Room 801A

Presented by: D. Ge

Author(s):

G. Poorman(1), P. Zhou(1), D. Vasquez-Montes(1), S. Horn(1), F. Segreto(1), C. Bortz(1), D. Ge(1), N. Stekas(1), J. Auerbach(2), J. Moon(1), J. Tishelman(1), M. Gerling(1), B. Diebo(3), R. de la Garza Ramos(1), J. Paul(1), P. Passias(1)

(1) New York University Langone Orthopedic Hospital, Division of Spinal Surgery, New York, NY, United States
(2) Bronx-Lebanon Hospital Center, Bronx, NY, United States
(3) SUNY Downstate Medical Center, Department of Orthopaedic Surgery, Brooklyn, NY, United States

Abstract

Introduction: Adult spinal deformity (ASD) is a common pathology that can lead to decreased quality of life, pain, physical limitations, and dissatisfaction with self-image. Durability of interventions for deformity treatment is of paramount concern to surgeons, as revision rates remain high. The aim of this study was to describe properties of ASD revisions relative to primary surgeries, and determine clinical variables that can predictor revision.

Methods: Retrospective review. Patients undergoing thoracolumbar fusion, five or more levels, for scoliosis (primary diagnosis ICD-9 737.x) were identified on a state-wide database. Primary and Revision (returning for refusion procedure) surgeries were compared based on demographic, hospital stay, and clinical characteristics. Differences between primary and revision surgeries, and predictors of primary surgeries requiring revision, utilized binary logistic regression controlling for age, comorbidity burden, and levels fused.

Results: 1063 patients (average 7.4 levels fused, mean age: 47.6 years, 69.0% female) who underwent operative treatment for ASD were identified, of which 123 (average 7.1 levels fused, 11.6%, mean age 61.43, 80.5% female) had revisions. Primary surgeries were ~0.3 levels longer (p=0.013), used interbody ~11% more frequently (p=0.020), and used BMP ~12% less frequently (p=0.008). Revisions occurred 176.4 days after the primary on average. The most frequent causes of revisions were: 43.09% implant failure, 24.39% acquired kyphosis, and 14.63% enduring scoliosis. After controlling for age, comorbidities, and levels fused older, more comorbid, female, and white-race patients were more likely to be revised. Upon multivariate regression, after controlling for age and levels fused, overall complications remained non-different (OR: 0.8, 95% CI: 0.6-1.2). However, revision remained an independent predictor for infection (OR: 5.5, 95% CI: 2.8-10.5).

Conclusions: In a statewide database with individual patient follow up of up to 4 years10% of ASD patients undergoing scoliosis correction required revision. Revision surgeries had higher infection incidence.