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• W4386041684 abstract "BACKGROUND CONTEXT Complex realignment procedures in ASD surgery are commonly performed for severe or rigid deformities. The relationship between patient and surgical characteristics, and preoperative radiographic criteria, and mechanical complications is continually evolving. We sought to report the incidence of reoperation for mechanical complications after ASD surgery and evaluate predictors. PURPOSE To identify reoperative radiographic criteria and patient and surgical characteristics that predict risk for reoperation for mechanical complications after adult spinal deformity (ASD) surgery, at long term followup. STUDY DESIGN/SETTING Retrospective review of prospectively collected single center database. PATIENT SAMPLE A total of 1037 patients (Age: 46 ± 23; Levels fused 10 ± 4) were assessed at an average follow-up of 37.5 ± 8.1 months. OUTCOME MEASURES Risk factors for mechanical complications, defined as reoperation for proximal junctional failure (PJF), rod fracture, or pseudarthrosis, were assessed. METHODS Patients undergoing ASD surgery, > 5 levels, coronal Cobb curve > 20°, with fixation to the pelvis, from 2011-2022 were included. Demographics, surgical variables, and radiographic measurements were assessed. Risk factors for mechanical complications, defined as reoperation for proximal junctional failure (PJF), rod fracture, or pseudarthrosis, were assessed. RESULTS There were 1037 patients (Age: 46 ± 23; Levels fused 10 ± 4) assessed at an average followup of 37.5 ± 8.1 months. One hundred twenty-five patients (12.1%) sustained a mechanical complication requiring reoperation: pseudarthrosis (42%); rod fracture (32%); PJF (26%). Reoperation occurred at 31.9 ± 17.2 months after the index procedure. Patients who sustained a mechanical complication had higher BMI (28.3 vs 25.1 kg/m2, p<0.001), were older (61 vs 44 years, p<0.001), and more frail (0.7 vs 0.4, p<0.001). There were no differences in distribution of medical comorbidities. Patients who sustained a mechanical complication had a higher preoperative T1 pelvis angle (TPA) (29° vs 22°, p=0.01), and greater preoperative lumbar fractional curve (13.1° vs 11.1°, p=0.04). At early postoperative radiographic followup (1 month), patients who went on to develop a mechanical complication had higher proximal junctional angle (PJA) (14.7° vs 9.8°, p<0.001), greater pelvic tilt (27.9° vs 23.4°, p<0.001), greater thoracic kyphosis (44.3° vs 40.8°, p=0.036), and less lumbar lordosis (40° vs 44°, p=0.006), with equivalent correction in the fractional curve. By regression analysis, immediate postoperative PJA (OR 1.04, p=0.027), and greater age (OR 1.1, p<0.001) were predictive of mechanical complications at minimum 2year followup. CONCLUSIONS Mechanical complications occur at a rate of 12.1%. Greater thoracic kyphosis, PJA, pelvic tilt, and less lumbar lordosis at early postoperative follow up, and older age were associated with mechanical complications at 2-year followup. FDA Device/Drug Status This abstract does not discuss or include any applicable devices or drugs. Complex realignment procedures in ASD surgery are commonly performed for severe or rigid deformities. The relationship between patient and surgical characteristics, and preoperative radiographic criteria, and mechanical complications is continually evolving. We sought to report the incidence of reoperation for mechanical complications after ASD surgery and evaluate predictors. To identify reoperative radiographic criteria and patient and surgical characteristics that predict risk for reoperation for mechanical complications after adult spinal deformity (ASD) surgery, at long term followup. Retrospective review of prospectively collected single center database. A total of 1037 patients (Age: 46 ± 23; Levels fused 10 ± 4) were assessed at an average follow-up of 37.5 ± 8.1 months. Risk factors for mechanical complications, defined as reoperation for proximal junctional failure (PJF), rod fracture, or pseudarthrosis, were assessed. Patients undergoing ASD surgery, > 5 levels, coronal Cobb curve > 20°, with fixation to the pelvis, from 2011-2022 were included. Demographics, surgical variables, and radiographic measurements were assessed. Risk factors for mechanical complications, defined as reoperation for proximal junctional failure (PJF), rod fracture, or pseudarthrosis, were assessed. There were 1037 patients (Age: 46 ± 23; Levels fused 10 ± 4) assessed at an average followup of 37.5 ± 8.1 months. One hundred twenty-five patients (12.1%) sustained a mechanical complication requiring reoperation: pseudarthrosis (42%); rod fracture (32%); PJF (26%). Reoperation occurred at 31.9 ± 17.2 months after the index procedure. Patients who sustained a mechanical complication had higher BMI (28.3 vs 25.1 kg/m2, p<0.001), were older (61 vs 44 years, p<0.001), and more frail (0.7 vs 0.4, p<0.001). There were no differences in distribution of medical comorbidities. Patients who sustained a mechanical complication had a higher preoperative T1 pelvis angle (TPA) (29° vs 22°, p=0.01), and greater preoperative lumbar fractional curve (13.1° vs 11.1°, p=0.04). At early postoperative radiographic followup (1 month), patients who went on to develop a mechanical complication had higher proximal junctional angle (PJA) (14.7° vs 9.8°, p<0.001), greater pelvic tilt (27.9° vs 23.4°, p<0.001), greater thoracic kyphosis (44.3° vs 40.8°, p=0.036), and less lumbar lordosis (40° vs 44°, p=0.006), with equivalent correction in the fractional curve. By regression analysis, immediate postoperative PJA (OR 1.04, p=0.027), and greater age (OR 1.1, p<0.001) were predictive of mechanical complications at minimum 2year followup. Mechanical complications occur at a rate of 12.1%. Greater thoracic kyphosis, PJA, pelvic tilt, and less lumbar lordosis at early postoperative follow up, and older age were associated with mechanical complications at 2-year followup." @default.
• W4386041684 created "2023-08-22" @default.
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• W4386041684 date "2023-09-01" @default.
• W4386041684 modified "2023-10-09" @default.
• W4386041684 title "P105. Risk factors for reoperation for mechanical complications after adult spinal deformity surgery: minimum 2-year followup" @default.
• W4386041684 doi "https://doi.org/10.1016/j.spinee.2023.06.330" @default.
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