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

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).