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Identification of Predictive Factors for Mechanical Complications After Adult Spinal Deformity Surgery: A
Atsuyuki Kawabata1, Toshitaka Yoshii1, Kenichiro Sakai2
1Department of Orthopedic Surgery, Tokyo Medical and Dental University, Bunkyo City, Tokyo, Japan.
Study Design:
A retrospective multicenter observational study.
Objective:
To investigate correction surgeries that were performed in relatively aged patients in terms of mechanical complications (MCs) and their predictive factors.
Summary Of Background Data:
The risk factors associated with MCs have not yet been well examined, especially in aged populations.
Methods:
We retrospectively reviewed 230 surgically treated ASD patients with an average age of 72.2 years. Twenty-eight patients with ASD caused by vertebral fractures were excluded. The minimum follow-up was 2 years. Postoperative MCs were defined as proximal junction kyphosis, distal junction kyphosis, pseudoarthrosis, rod breakage, and vertebral fractures. We divided all the ASD patients into two groups: patients with MC (the MC (+) group) and patients without MC (the MC (-) group). Radiographic parameters were evaluated before and immediately after surgery. The SRS-Schwab ASD classification and global alignment and proportion (GAP) score were also evaluated.
Results:
Of the 202 patients, 91 (45.0%) had MCs. The age at surgery was significantly higher in the MC (+) group than in the MC (-) group. Regarding radiographic parameters, postoperative global tilt (GT), pre- and postoperative thoracolumbar kyphosis (TLK), and postoperative thoracic kyphosis were significantly higher in the MC (+) group than in the MC (-) group. Other parameters, such as the proposed ideal alignment target of PI-LL<10, did not significantly affect MC rates. The GAP score was high in both groups and not significantly related to a higher rate of MC. Forward stepwise logistic regression indicated that the age at surgery, postoperative GT, and preoperative TLK were significant risk factors for MCs.
Conclusion:
Older age, higher postoperative GT, and higher pre and postoperative TLK can be risk factors for MCs. The GAP score was high in both groups and not significantly related to a higher rate of MC.
Level Of Evidence:
4.
