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Thread: Complication rates for adult scoliosis surgery

  1. #1
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    Complication rates for adult scoliosis surgery

    Scoliosis Research Society Morbidity and Mortality of Adult Scoliosis Surgery

    Sansur, Charles A.; Smith, Justin S.; Coe, Jeff D.; Glassman, Steven D.; Berven, Sigurd H.; Polly, David W. Jr.; Perra, Joseph H.; Boachie-Adjei, Oheneba; Shaffrey, Christopher I.

    Spine. 36(9):E593-E597, April 20, 2011.

    Study Design. A retrospective review.

    Objective. To obtain an assessment of complication incidence using the largest known database of adult scoliosis and to determine whether the rate of complication depends on various clinical parameters.

    Summary of Background Data. The Scoliosis Research Society (SRS) morbidity and mortality database has previously been used to assess complication rates in adolescents undergoing scoliosis correction. To better understand complications in adults, degenerative and idiopathic adult scoliosis (AS) cases were studied.

    Methods. The SRS morbidity and mortality database was queried to identify cases of AS from 2004 to 2007. Complications were identified and analyzed on the basis of patient type of scoliosis (degenerative vs. adult idiopathic), age, use of osteotomy, revision surgery status, and surgical approach. Age was stratified into less than or equal to 60 and greater than 60. Surgical approach was stratified into anterior only, posterior only, and combined anterior/posterior.

    Results. A total of 4980 cases of AS were submitted from 2004 to 2007. There were 521 patients with complications (10.5%), and a total of 669 complications (13.4%). The most common complications were dural tear 142 (2.9%), superficial wound infection 46 (0.9%), deep wound infection 73 (1.5%), implant complication 80 (1.6%), acute neurological deficits 49 (1.0%), delayed neurological deficits 41 (0.5%), epidural hematoma 12 (0.2%), wound hematoma 22 (0.4%), pulmonary embolus 12 (0.2%), and deep venous thrombosis 9 (0.2%). There were 17 deaths (0.3%). There were 2555 patients with degenerative and 2425 patients with adult idiopathic scoliosis. Complication rates in these two groups were not significantly different (11.0% and 9.9%, respectively, P = 0.20). Age was not associated with complication rate (P = 0.32). Significantly higher complication rates were identified in osteotomies, revision surgery, and/or combined anterior-posterior surgery (P = 0.0006, 0.006, and 0.03, respectively).

    Conclusions. The overall complication rate for AS treatment is 13.4%. Complication rate is significantly higher when osteotomies, revision procedures, and combined anterior/posterior approaches are used. Complication rate is not influenced by scoliosis type or age.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
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    "We are all African."

  2. #2
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    Thanks for the thread, Sharon. It was interesting. I guess I survived my two osteotomies ok. (smile)
    66 and still heartbroken...
    2007 52 w/ severe lumbar stenosis & L2L3 lateral listhesis (side shift)
    5/4/07 posterior spinal fusion T2-L4 w/ laminectomies and osteotomies @L2L3, L3L4
    Dr. Kim Hammerberg, Rush Univ. Medical Center in Chicago

    Corrected to 15
    2014 DXd w/CMT (type 2)

    Click to view my pics: pics of scoli x-rays digital x-rays, and pics of me

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    Sharon

    Thanks for posting this. This subject is one that I have read about in the past, and have been warned about prior to my surgeries. I have been afraid to post on this in any detail, as it can be a delicate subject matter for some.

    Any good surgeon should review complications as mine did with me. Its something that we have to stomach, and its also something that we need plenty of time to absorb. Its also make us “zombies” after we set our dates.....

    I was guaranteed that something would go wrong in my surgeries. You might say that I was one of those that almost used up his surgical time window, and was out of time. I had way too much damage. I managed to slip through the door before it slammed shut. Dr Menmuir saved my life, no doubt.

    I lost my gall bladder. I figure that was just a small sacrifice and was fortunate to come out as well as I did.

    BTW, I went motocross riding today...what a workout!
    Ed
    Last edited by titaniumed; 04-15-2011 at 02:59 AM.
    49 yr old male, now 58, the new 53...
    Pre surgery curves C12,T70,L70
    ALIF/PLIF T2-Pelvis 01/29/08, 01/31/08 7" pelvic anchors BMP
    Dr Brett Menmuir St Marys Hospital Reno,Nevada

    Bending and twisting pics after full fusion
    http://www.scoliosis.org/forum/showt...on.&highlight=

    My x-rays
    http://www.scoliosis.org/forum/attac...2&d=1228779214

    http://www.scoliosis.org/forum/attac...3&d=1228779258

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    Ti Ed,

    Perhaps you missed them but there have been other posts of articles on complication rates for this surgery. This is probably the fourth or fifth I have seen on the group in just the last few years for adult surgery.

    Research articles like this have the least chance of being erroneous because they are simply counting beans. The surgery articles, as a group, are far superior than all the other articles on bracing and etiology because of this. There is a very high fluff factor outside of bean counting because this is such a hard field to do defensible research.

    Knowledge is power. Power to the people. :-)

    Good job on the motocross! I guess you never sit done during that, yes?
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  5. #5
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    ps. ATTICA! ATTICA! ATTICA!
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

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    I knew this was coming, and have been anxious to comment on it. The really surprising thing about this study is that age did not affect complication rates. I don't have the full text yet to verify, but if it's true, it should be really good news for those who are having trouble deciding on whether to have surgery. Knowing that they can have surgery at 50 or 60 years old without having to worry about a higher complication rate, is a really good thing. The one thing that I think might be affecting this, however, is that the "better" surgeons are the ones who are operating on the older patients. (I know quite a few surgeons who won't do scoliosis surgery on anyone over about 50.) Assuming that those "better" surgeons have fewer complications, it could skew the results.

    --Linda
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Dilbert
    I'm sarcastic... what's your super power? --Unknown
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    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation
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  7. #7
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    I sure would like to see complication stats in 5 year age groups. 20-25, 25-30 and all the way up.
    They should list ALL complications, all the stats.

    I have trouble believing that complication rate is not affected by age.

    Sharon
    Yes, I do sit down, (in the smoother sections). I need to post video of a steep hill climb some day. Its a complication of the brain,(mine) combination mid life crisis thing...

    Ed
    49 yr old male, now 58, the new 53...
    Pre surgery curves C12,T70,L70
    ALIF/PLIF T2-Pelvis 01/29/08, 01/31/08 7" pelvic anchors BMP
    Dr Brett Menmuir St Marys Hospital Reno,Nevada

    Bending and twisting pics after full fusion
    http://www.scoliosis.org/forum/showt...on.&highlight=

    My x-rays
    http://www.scoliosis.org/forum/attac...2&d=1228779214

    http://www.scoliosis.org/forum/attac...3&d=1228779258

  8. #8
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    i thought that young people...especially as young as teen agers...heal better/faster...so i figured that was one of the things leading to better results in younger patients...just a general better healing for any kind of surgery....not necessarily spinal surgery...
    i agree with what TiEd said....i'd love to see stats broken down by small increases in age groups, as he mentioned....
    i still believe younger people, especially kids, just plain rebound faster from illness when it comes to recuperating from any procedure


    question..."older people are getting shorter fusions"...? what is this based on...?
    i thought older people often end up with longer fusions, to avoid revision later, and because the older one is, the more damage one may have to their spine...

    jess
    Last edited by jrnyc; 04-16-2011 at 01:06 PM.

  9. #9
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    Quote Originally Posted by jrnyc View Post
    i thought that young people...especially as young as teen agers...heal better/faster...so i figured that was one of the things leading to better results in younger patients...just a general better healing for any kind of surgery....not necessarily spinal surgery...
    i agree with what TiEd said....i'd love to see stats broken down by small increases in age groups, as he mentioned....
    i still believe younger people, especially kids, just plain rebound faster from illness when it comes to recuperating from any procedure


    question..."older people are getting shorter fusions"...? what is this based on...?
    i thought older people often end up with longer fusions, to avoid revision later, and because the older one is, the more damage one may have to their spine...

    jess
    Since this study only included adults, I'm guessing that no one under the age of 18 was included. I'm going into the office on Monday, and should be able to access the final full text of this article. I'll post more after I've had a chance to read it all.

    --Linda
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Dilbert
    I'm sarcastic... what's your super power? --Unknown
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation
    ---------------------------------------------------------------------------------------------------------------------------------------------------
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  10. #10
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    Hmmmm ... interesting study. Am I a statistical anomaly or just lucky?

    Complications - None from five surgeries, most recently in March with Dr. Lenke.

    Revisions/osteotomies - Both. No complications whatsoever.

    Short fusions - Mine is T1 to sacrum.

    Age - My surgeries started at age 57; I turned 68 just four weeks after my most recent surgery. Dr. Lenke did make a point of telling me that my age IS a complicating factor.

    Whatever it is, I'm very grateful that I am surviving all of this. And I deeply hope that Dr. Lenke has finally put an end to any more surgeries for me.
    FeliciaFeliciaFelicia
    10/24/00 posterior fusion T4-L4 at age 57
    8/5/05 posterior surgery for spinal stenosis at L4-L5; laminectomy and fusion
    5/14/07 posterior revision with fusion to sacrum
    2/11/08 anterior discectomy L5-S1, and reinforcement of fusion with plate attached to L5-S1
    3/9/2011 and 3/11/2011 revision surgery with Dr. Lenke, St. Louis - complete revision and fusion with instrumentation from T1 to sacrum, one lumbar osteotomy.

  11. #11
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    Quote Originally Posted by hdugger View Post
    Alot of older people with degenerative scoliosis (so, not the idiopathic kind, but the kind that starts in adulthood) end up with shorter fusions, I think. Linda will know, but it seems like it's pretty common to just fuse directly at the curve and leave the rest alone.
    Agreed, I think it's more common for surgeons to choose fewer levels for degenerative curves.

    --Linda
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Dilbert
    I'm sarcastic... what's your super power? --Unknown
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    If you've signed up and are having trouble posting, please check your spam folder. An email was sent to the email address which you subscribed. You have to follow the instructions in that email. Done that and still having trouble posting? Contact Joe O'Brien at jpobrien@scoliosis.org.

  12. #12
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    Quote Originally Posted by trulyaries View Post
    Hmmmm ... interesting study. Am I a statistical anomaly or just lucky?

    Complications - None from five surgeries, most recently in March with Dr. Lenke.

    Revisions/osteotomies - Both. No complications whatsoever.

    Short fusions - Mine is T1 to sacrum.

    Age - My surgeries started at age 57; I turned 68 just four weeks after my most recent surgery. Dr. Lenke did make a point of telling me that my age IS a complicating factor.

    Whatever it is, I'm very grateful that I am surviving all of this. And I deeply hope that Dr. Lenke has finally put an end to any more surgeries for me.
    Not sure I understand. With only a 10.5% complication rate overall, it would be expected that you wouldn't have any complications.
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Dilbert
    I'm sarcastic... what's your super power? --Unknown
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    If you've signed up and are having trouble posting, please check your spam folder. An email was sent to the email address which you subscribed. You have to follow the instructions in that email. Done that and still having trouble posting? Contact Joe O'Brien at jpobrien@scoliosis.org.

  13. #13
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    Quote Originally Posted by trulyaries View Post
    Hmmmm ... interesting study. Am I a statistical anomaly or just lucky?

    Complications - None from five surgeries, most recently in March with Dr. Lenke.

    Revisions/osteotomies - Both. No complications whatsoever.

    Short fusions - Mine is T1 to sacrum.

    Age - My surgeries started at age 57; I turned 68 just four weeks after my most recent surgery. Dr. Lenke did make a point of telling me that my age IS a complicating factor.

    Whatever it is, I'm very grateful that I am surviving all of this. And I deeply hope that Dr. Lenke has finally put an end to any more surgeries for me.
    Can I ask if you have any osteopenia or osteoporosis or some bone thinning issue? I have gotten the "vibe" (i.e., based on nothing defensible) from reading all these testimonials that the people without those issues tend to do better.

    I'm glad you have come through all that. I told my daughters that if it wasn't fixed the first time that the surgeon would fix it on the next go around. You are living proof that these things can eventually be fixed if folks don't wait too long and miss their window.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  14. #14
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    Closer look at complications

    The most common complications were:

    dural tear 142 (2.9%)
    superficial wound infection 46 (0.9%)
    deep wound infection 73 (1.5%)
    implant complication 80 (1.6%)
    acute neurological deficits 49 (1.0%)
    delayed neurological deficits 41 (0.5%)
    epidural hematoma 12 (0.2%)
    wound hematoma 22 (0.4%)
    pulmonary embolus 12 (0.2%)
    deep venous thrombosis 9 (0.2%)
    deaths (0.3%)

    As far as I know (which is not far), only two of these... some (few?) neurological deficits and death are the only "permanent" complications. The rest resolve or can be fixed.

    Maybe as little as ~0.5% of the complications persist. That seems like the more relevant statistic that a patient would want to know and is considerably less than the 13.4%. Sure some roads are rougher than others and I am not downplaying that. Some of these things sound serious and painful! But I think the end game is the entire game here in terms of deciding on surgery for gray area cases.

    I am just guessing because neither of my kids was gray area... there was one rational choice. But many adults do seem to have a choice and a much larger time window than kids in the surgical range.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  15. #15
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    Sharon,
    I have mild osteopenia.
    FeliciaFeliciaFelicia
    10/24/00 posterior fusion T4-L4 at age 57
    8/5/05 posterior surgery for spinal stenosis at L4-L5; laminectomy and fusion
    5/14/07 posterior revision with fusion to sacrum
    2/11/08 anterior discectomy L5-S1, and reinforcement of fusion with plate attached to L5-S1
    3/9/2011 and 3/11/2011 revision surgery with Dr. Lenke, St. Louis - complete revision and fusion with instrumentation from T1 to sacrum, one lumbar osteotomy.

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