Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Meta-Anal. Dec 26, 2017; 5(6): 132-149
Published online Dec 26, 2017. doi: 10.13105/wjma.v5.i6.132
Different types of mechanical complications after surgical correction of adult spine deformity with osteotomy
Cameron Barton, Andriy Noshchenko, Vikas V Patel, Christopher M J Cain, Christopher Kleck, Evalina L Burger
Cameron Barton, Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA 52242, United States
Andriy Noshchenko, Vikas V Patel, Christopher M J Cain, Christopher Kleck, Evalina L Burger, Department of Orthopedics, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045, United States
Author contributions: Barton C substantial contributions to conception and design of the study, acquisition of data, and drafting of the article; Noshchenko A provided statistical analysis and interpretation of the obtained results, drafting the article; Patel VV, Cain CMJ and Kleck C contributed equally to this work making critical revisions related to important intellectual content of the manuscript; Burger LE provided data quality control, critical revision of the manuscript and final approval of the version of the article to be published.
Supported by Medicrea (New York, NY 10013, United States).
Institutional review board statement: The study was reviewed and approved by the Colorado Multiple Institutional Review Board (COMIRB), Protocol #12-1458.
Informed consent statement: Specific consent was not applicable due to the retrospective design of the study; personal data of the patients were not collected for the study.
Conflict-of-interest statement: Barton C, Medicrea (financial support); Noshchenko A, NIH (Grant/Research Support); Patel VV, Medtronic, SI-bone, NIH (Grants/Research Support), Aesculap and SI-Bone (Consultant); Cain CMJ, DePuy, Synthes, and AOSpine (Consultant); Kleck C, Synthes (Research Support); Burger EL, Medicrea (Consultant), DePuy, Synthes (Grants/Research Support).
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Andriy Noshchenko, PhD, Department of Orthopedics, University of Colorado, Anschutz Medical Campus, 13001 E 17, Building 500, Mail Stop 432, Aurora, CO 80045, United States. andriy.noshchenko@ucdenver.edu
Telephone: +1-303-2586448 Fax: +1-303-7240919
Received: September 15, 2017
Peer-review started: September 16, 2017
First decision: November 7, 2017
Revised: November 21, 2017
Accepted: December 3, 2017
Article in press: December 3, 2017
Published online: December 26, 2017
Processing time: 101 Days and 6.1 Hours
ARTICLE HIGHLIGHTS
Research background

It has been pointed out during last decades that mechanical complications (MC) after surgical correction of adult spine deformity (ASD) are most typical, and often require additional surgical treatment. However, these complications were not clearly defined. Their specific appearances, incidence, distribution by postoperative follow-ups, and risk factors were not studied well.

Research motivations

New knowledge concerning nature and causes of the MC would enable diminish their occurrence and improve postoperative clinical outcomes after surgical correction of ASD.

Research objectives

The main objectives of the study were identification of the most clinically relevant MC seen after surgical correction of ASD with corrective osteotomies, defining of their incidence, the most likelihood period of occurrence, association with additional surgeries; revealing of risk factors and assessment their predictive value. Achievement of these purposes would have enabled formulation of grounded recommendation to diminish risk of such complications and contribute to defining directions for further research in this field.

Research methods

The retrospective clinical study was performed. Medical records, operation protocols, and radiographic images were studied in patients who underwent surgical correction of adult spine deformity with osteotomy. Preoperative, perioperative, and postoperative data were collected for 2 and more years of follow-up. Postoperative mechanical failures of spine and implanted instrumentation were studied in detail including: their features, latent periods, incidence, required additional treatment, and different risk factors such as: Demographic, preoperative and postoperative spinopelvic alignment, level of correction, spinal instrumentation, features of surgical intervention, etc.

Research results

It was shown that around half of patients experienced MC during two postoperative years; majority of these cases required additional surgery. MC of spine occurred earlier and more often required revision than breakage of the instrumentation. The main risk factors included severe preoperative sagittal imbalance, inadequate correction of the spinopelvic alignment, preoperative comorbidities (osteoporosis, smoking), postoperative events (falls), and features of the spinal instrumentation. There was developed method that enables recognition of patients with high risk of postoperative MC.

Research conclusions

The performed study is first that performed a clear classification of the clinically relevant MC after surgical correction of ASD with osteotomy. In particular, there were specified those complications that are linked with failure of spine, breakage of the instrumentation; and disassociation between different elements of the spinal fusion construct. First time, impact of more than 50 potential risk factors of the MC and their combinations was assessed. There were revealed risk factors and their combinations that had statistically significant association with one or a few MC. The predictive value of each of these risk factors for each type of MC was evaluated. The obtained results allowed development of a new method to recognize patients with high risk of postoperative MC; and provide newel grounded recommendations to diminish risk of such complications. Implication for clinical practice: implementation of these methods can contribute to improvement of treatment outcomes after surgical correction of ASD with osteotomy, and diminish treatment expenses.

Research perspectives

The obtained results and recommendations require further confirmation by studies with higher level of evidence such as prospective cohort and randomized clinical trials. The predictive capability of the risk factors revealed in the current study showed underestimation of risk of MC after surgical correction of ASD. It suggests that other currently unknown risk factors likely also exist. Therefore, further researches are needed in this field to reveal these factors.