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Revision Rate After Adult Deformity Surgery
Steven D Glassman1, John R Dimar1, Leah Y Carreon2
1Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40202, USA; Department of Orthopaedic Surgery, University of Louisville School of Medicine, 550 S. Jackson Street, 1st Floor ACB, Louisville, KY 40202, USA.
Adult spinal deformity surgery has an 18% revision rate within 4 years, indicating a need for improved techniques. This rate is unsustainable and requires focused efforts to reduce complications and enhance patient outcomes.
Area of Science:
- Orthopedic Surgery
- Spinal Surgery
- Epidemiology
Background:
- Surgical treatment for adult spinal deformity has advanced, yet revision surgery remains a significant concern.
- The precise rate and long-term implications of revision surgery are not well-defined.
Purpose of the Study:
- To determine the revision rate following multilevel spinal fusion for adult spinal deformity.
- Establish a benchmark for future efforts to improve surgical outcomes.
Main Methods:
- An epidemiological study utilizing national insurance databases (Medicare and private payer) from 2005-2011.
- International Classification of Diseases, Ninth Revision and Current Procedural Terminology codes identified patients undergoing spinal fusion and subsequent revision procedures.
Main Results:
- A cumulative 4-year revision rate of 19% was observed in the Medicare cohort and 16% in the private payer cohort.
- Pooled data revealed an overall 18% revision rate at 4 years postoperatively.
- Initial revision rates were inversely proportional to age, but this difference diminished over time.
Conclusions:
- Despite improved surgical techniques, the 18% 4-year revision rate is clinically and economically unsustainable.
- This study highlights the critical need for interventions to reduce revision rates in adult spinal deformity surgery.
