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Staged posterior surgery for severe adult spinal deformity
John M Rhee1, Keith H Bridwell, Lawrence G Lenke
1Department of Orthopaedic Surgery, Washington University School of Medicine, One Barnes-Jewish Hospital Plaza, St. Louis, MO 63110, USA.
Spine
|September 23, 2003
Summary
Staged posterior surgery safely divides complex procedures into two stages, reducing risks for high-risk adult deformity patients. This approach yields excellent outcomes with minimal complications, making it a viable option for challenging revision surgeries.
Area of Science:
- Spine surgery
- Orthopedic surgery
- Adult deformity correction
Background:
- Complex revision adult deformity surgery poses risks due to prolonged posterior procedures.
- Extended surgery times can lead to hemodynamic complications.
Purpose of the Study:
- To evaluate the safety and efficacy of staging complex posterior surgeries.
- To divide one prolonged posterior procedure into two staged surgeries within one hospitalization.
Main Methods:
- Retrospective analysis with prospective outcomes of 42 adult patients undergoing staged posterior surgery.
- First stage: implant removal, decompression, new fixation. Second stage (5-7 days later): osteotomies, instrumentation, fusion.
- Anterior surgery performed as needed during either stage.
Main Results:
- No major perioperative medical complications (e.g., MI, PE, death).
- Low rates of surgical complications (1 deep infection, 1 superficial infection, 1 seroma).
- Excellent outcomes (SRS-24, radiographic) at >= 2-year follow-up.
Conclusions:
- Staged posterior surgery is safe and effective for high-risk patients with complex adult deformity.
- This strategy minimizes hemodynamic stress and surgical complications.
- Excellent functional and radiographic outcomes can be achieved with this approach.