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).
| Original language | English (US) |
|---|---|
| Pages (from-to) | 131-137 |
| Number of pages | 7 |
| Journal | Spine Deformity |
| Volume | 4 |
| Issue number | 2 |
| DOIs | |
| State | Published - Mar 1 2016 |
Funding
Author disclosures: JLG (consultancy fees from Medtronic, LifeSpine, Acuity, Corelink, Pacira Pharmaceuticals, PAKmed, Alphatec, Stryker, Gerson Lehrman Group; employed with Norton Healthcare; payment for lectures from Medtronic, LifeSpine, Pacira, MiMedix, Alphatec; travel fees from Acuity and Medtronic; and other from OREF, AO Spine, American Journal of Orthoapedics, and The Spine Journal), LGL (consultancy fees from DePuy Synthes Spine, K2M, Medtronic; institutional grants from AOSpine & Scoliosis Research Society, Axial Biotech, DePuy Synthes Spine; payment for lectures from DePuy Synthes Spine, K2M; royalties from Medtronic, Quality Medical Publishing; travel fees from AOSpine, BroadWater, DePuy Synthes Spine, K2M, Medtronic, Seattle Science Foundation, Scoliosis Research Society, Stryker Spine, The Spinal Research Foundation; and other from AOSpine North America and Philanthropic research funding), DB (grants from the North American Spine Society), JZ (none), PS (none), IK (none), RR (none), LYC (board membership from Spine, The Spine Journal, University of Louisville Institutional Review Board, Medtronic, Scoliosis Research Society Directed Research Task Force, ScoliRisk Subcommitee; employed with Norton Healthcare; grants from Norton Healthcare, AO Spine, Scoliosis Research Society, Orthopedic Research and Educational Fund, travel fees from Orthopedic Research and Educational Fund, National Institutes of Health, University of Louisville Institutional Review Board, Department of Defense, Association for Collaborative Spine Research, Center for Spine Surgery and Research, Region of Southern Denmark; other from National Institutes of Health, Medtronic, Children's Tumor Foundation, and Nuvasive).
Keywords
- Adult deformity
- Complications
- Staged-surgery
- Vertebral column resections
ASJC Scopus subject areas
- Orthopedics and Sports Medicine