Complication rates for adult scoliosis surgery

[Ballet Mom]

Not sure I understand. With only a 10.5% complication rate overall, it would be expected that you wouldn't have any complications.

Perhaps you missed the conclusion of the study, which it appears, is what trulyaries is getting at:

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.

[Ballet Mom]

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%.

You have absolutely NO way of determining this. You have crossed the line into promotion and marketing. (The 0.5% you guesstimate is actually rather humorous seeing as the death rate is 0.3% itself. Death is certainly a persisting complication).

I also notice that chronic pain doesn't seem to have been listed as a complication of these surgeries. And we know from the researcher at Stanford Medical School that ten percent of surgeries, as a whole, lead to chronic unremitting pain.

[Pooka1]

You have absolutely NO way of determining this. You have crossed the line into promotion and marketing. (The 0.5% you guesstimate is actually rather humorous seeing as the death rate is 0.3% itself. Death is certainly a persisting complication).

It's like this...

http://squee.icanhascheezburger.com/...o-squee-scale/

[LindaRacine]

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.

I don't know if it got mentioned in this study, but we've found that when you get to 6 months postop, the patients with complications have almost exactly the same satisfaction rate as patients without complications.

--Linda

[LindaRacine]

Perhaps you missed the conclusion of the study, which it appears, is what trulyaries is getting at:

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.

Yes, but I think that patients with osteotomies, revisions, and combined A/P approaches, have complication rates somewhere around 30%, which would mean the majority of patients have no complications.

[Pooka1]

I don't know if it got mentioned in this study, but we've found that when you get to 6 months postop, the patients with complications have almost exactly the same satisfaction rate as patients without complications.

--Linda

I would have guessed that. There is a reason folks proceed with this surgery and it is because the alternative is almost always worse.

And for such complex surgery, the fact that there is a tiny permanent complication rate is a great tribute to the surgeons and neurologists who developed the fusion and cord monitoring techniques. It's jaw-dropping to think about it. I'm wondering if this surgery is actually safer than many other classes of surgery not involving spine. It might be given how low the complication rates are, both for temporary and permanent issues.

[Pooka1]

Yes, but I think that patients with osteotomies, revisions, and combined A/P approaches, have complication rates somewhere around 30%, which would mean the majority of patients have no complications.

Even the vast majority of the people with these more complicated procedures come out with no complications apparently.

These guys are amazing.

[Ballet Mom]

Yes, but I think that patients with osteotomies, revisions, and combined A/P approaches, have complication rates somewhere around 30%, which would mean the majority of patients have no complications.

Yes, I do realize that would mean the rate for those without those procedures would be lower. That's certainly good news. Unfortunately, I don't believe there's a way of actually predicting who ends up needing the revision procedures, is there?

Also, do they not consider chronic pain as a complication since it isn't actually diagnosed during the hospital stay?

Just to make clear...I'm not saying people shouldn't get the procedure if it's truly necessary. I think it doesn't do anyone any good, though, to go into these procedures blind and think that they are not at all at risk. Better to go into the surgery and come out pleasantly surprised, then to go in and be mentally unprepared for ending up as a statistic in someone's study.

[LindaRacine]

Yes, I do realize that would mean the rate for those without those procedures would be lower. That's certainly good news. Unfortunately, I don't believe there's a way of actually predicting who ends up needing the revision procedures, is there?

Also, do they not consider chronic pain as a complication since it isn't actually diagnosed during the hospital stay?

Just to make clear...I'm not saying people shouldn't get the procedure if it's truly necessary. I think it doesn't do anyone any good, though, to go into these procedures blind and think that they are not at all at risk. Better to go into the surgery and come out pleasantly surprised, then to go in and be mentally unprepared for ending up as a statistic in someone's study.

Not all complications are diagnosed during the hospital stay.

Yes, a lot of patients who have had scoliosis surgery have chronic pain. Wanna bet that the scoliosis patients who had curves >40 degrees who haven't had surgery, have a higher rate of chronic pain than those who had surgery?

[Pooka1]

But only of these surgical type complications, I would think. If the complication is PJK or sagital imbalance, non-union, or pain, I'd think they'd still be unhappy six months out. In fact, I'd think they'd be *more* unhappy, since people expect things to be not right directly after the surgery but become increasingly unhappy when things don't improve.

This is a non-sequitor.

The article is about surgical complications, not need for revision surgery which seems to be largely if not completely unrelated to surgical complications. And need for revision might be as much related to the patient as they present than to any mistake or poor judgment on the surgeon's part.

[Pooka1]

Not all complications are diagnosed during the hospital stay.

Yes, a lot of patients who have had scoliosis surgery have chronic pain. Wanna bet that the scoliosis patients who had curves >40 degrees who haven't had surgery, have a higher rate of chronic pain than those who had surgery?

Yes. The error in thinking here is identical to that made by the anti-surgery types in that they are comparing surgical outcome to NORMAL spines. The correct comparison is to non-fused abnormal spines... if these folks are even alive to ask in some cases.

There is a reason these surgeries are ethical though some apparently deny that fact.

[Ballet Mom]

Not all complications are diagnosed during the hospital stay.

Yes, a lot of patients who have had scoliosis surgery have chronic pain. Wanna bet that the scoliosis patients who had curves >40 degrees who haven't had surgery, have a higher rate of chronic pain than those who had surgery?

It would be an interesting study, wouldn't it? It does seem strange that so many orthopedists claim that scoliosis doesn't cause pain.

[Pooka1]

It would be an interesting study, wouldn't it? It does seem strange that so many orthopedists claim that scoliosis doesn't cause pain.

They have claimed that for KIDS. This thread is about ADULTS where pain might be the MOST common reason for fusion. You don't need to be an orthopedic surgeon to realize very quickly that long-standing scoliosis causes pain in adults.

[Ballet Mom]

They have claimed that for KIDS. This thread is about ADULTS where pain might be the MOST common reason for fusion. You don't need to be an orthopedic surgeon to realize very quickly that long-standing scoliosis causes pain in adults.

Wait a second, I thought pain wasn't supposed to be a reason for scoliosis surgery, because no one can guarantee that pain will be eliminated via the surgery. This all changes for adults?

Adults also are more likely to have rigid curves that require the procedures that can cause more complications, but I guess that's a non-issue because everyone's happy at six months anyway.

[Pooka1]

Wait a second, I thought pain wasn't supposed to be a reason for scoliosis surgery, because no one can guarantee that pain will be eliminated via the surgery. This all changes for adults?

Adults also are more likely to have rigid curves that require the procedures that can cause more complications, but I guess that's a non-issue because everyone's happy at six months anyway.

It's like this...

http://icanhascheezburger.com/2011/0...nies-in-a-hat/