Nationwide Trends and Safety Analysis of Adult Spinal Instrumentation Surgery: A Study using the JSIS-DB

Spinal instrumentation surgery is increasingly being performed in aging populations; however, comprehensive data regarding the nationwide trends and perioperative safety associated with these procedures in Japan remain limited. This study aimed to evaluate the epidemiological characteristics and complication profiles of adult spinal instrumentation surgery using the Japanese Spinal Instrumentation Society Database (JSIS-DB).

A retrospective observational study was conducted using JSIS-DB data from 2018 to 2022. Adults aged ≥18 years who underwent spinal surgeries involving instrumentation across intervertebral levels were included. Data for demographic characteristics, diagnosis, surgical procedure, operative time, blood loss, and complications within 14 days of surgery were analyzed. The primary outcome was the overall perioperative complication rate, whereas the secondary outcomes included complication rates stratified by age and pathology.

A total of 28,832 cases were analyzed (mean age: 67.3±14.4 years; males: 48.7%). The most common diagnosis was degenerative disease (62.9%), followed by spinal deformity (15.4%), trauma (15.2%), tumors (3.5%), and infection (2.6%). The most frequently performed procedure was posterior lumbar interbody fusion (40.8%), followed by posterior or posterolateral fusion (32.6%). The overall complication rate was 11.0%. The specific complication rates were as follows: dural tears, 2.5%; nerve root disorders, 1.4%; epidural hematomas, 1.1%; surgical-site infections, 0.8%; spinal cord disorders, 0.4%; and mortality, 0.1%. Patients aged ≥90 years showed a significantly higher complication rate (18.6%, p<0.001). The complication rates by pathology were as follows: deformities, 13.9%; infections, 13.4%; tumors, 13.3%; trauma, 12.3%; and degenerative diseases, 9.8% (p<0.001).

This nationwide registry-based study successfully visualized the real-world practices and risk profiles of adult spinal instrumentation surgery in Japan. Elderly patients and those with deformities, infections, or tumors showed significantly higher perioperative risks, highlighting the need for enhanced preoperative assessments and perioperative care. These findings provide foundational data to improve the safety and quality of spinal surgery.