Prevalence and risk factors for unplanned return to oroom for complex adult spinal deformity patients: scoli-risk 1 prospective multicenter international study

Podium Presentation Abstracts: Paper no. 59SUMMARY: This is a prospective, multicentre international study of 272 subjects undergoing complex adult spine deformity (ASD) surgery with 2 year follow-up. The prevalence of unplanned return to operating room (OR) was 22% overall, with 4% within 30 days of index surgery. Risk factors included a more severe neurological deficit, older age, smokers, diabetes, hypertension, and osteoporosis. HYPOTHESIS: The prevalence of unplanned return to OR after ASD surgery is high. DESIGN: A prospective, multicentre international study. INTRODUCTION: A high-risk of complications had been noted in complex ASD surgery. This study reports the prevalence and risk factors of unplanned return to OR in ASD patients who underwent surgical treatment. METHODS: ASD patients who underwent surgical treatment were enrolled prospectively as part of the Scolirisk 1 study and followed for 2 years. Clinical profiles and complications were recorded preoperatively and throughout the follow-up period. RESULTS: 272 ASD patients were assessed. A total of 86 unplanned additional spine surgeries were performed on 60 subjects(22%). Eleven additional surgeries were performed within 30 days of the indexed surgery, 6 of which were due to wound infections, and one each of dural tear, CSF leak, inadequate correction, implant failure, graft dislodgement. For those returned to the operating room after 30 days from the indexed surgery (75), causes included implant failure(46%), wound infections (22%), loss of correction(16%), pseudarthrosis(15%), proximal junctional kyphosis(7%), adjacent segment problems(8%), screw loosening(5%), screw malposition(5%), prominent implants(3%), and vertebral fracture(3%). Preexisting risk factors that predicted one or more unplanned return to surgery included a more severe neurological deficit (p=0.01), older age (p=0.05), smokers (p=0.03), diabetes (p=0.05), hypertension (p=0.04), and osteoporosis (p=0.02). CONCLUSION: There is a high rate of unplanned return to OR after complex ASD surgery. Risk factors were determined and maybe useful for preoperative counselling of patients undergoing such surgeries, as well as clinical decision making

Early postoperative MRI in detecting hematoma and dural compression after lumbar spinal decompression: prospective study of asymptomatic patients in comparison to patients requiring surgical revision

Early postoperative MRI after spinal surgery is difficult to interpret because of confounding postoperative mass effects and frequent occurrence of epidural hematomas. Purpose of this prospective study is to evaluate prevalence, extent and significance of hematoma in the first postoperative week in asymptomatic patients after decompression for lumbar stenosis and to determine the degree of clinically significant dura compression by comparing with the patients with postoperative symptoms. MRI was performed in 30 asymptomatic patients (47 levels) in the first week after lumbar spine decompression for degenerative stenosis. Eleven patients requiring surgical revision (16 levels) for symptomatic early postoperative hematoma were used for comparison. In both groups the cross-sectional area of the maximum dural compression (bony stenosis and dural sac expansion) was measured preoperatively and postoperatively by an experienced radiologist. Epidural hematoma was seen in 42.5% in asymptomatic patients (20/47 levels). The median area of postoperative hematoma at the operated level was 176 mm2 in asymptomatic patients and 365 mm2 in symptomatic patients. The median cross-sectional area of the dural sac at the operated level was 128.5 and 0 mm2 in asymptomatic and symptomatic patients, respectively, at the site of maximal compression. In the symptomatic group 75% of the patients had a maximal postoperative dural sac area of 58.5 mm2 or less, whereas in the asymptomatic group 75% of patients with epidural hematoma had an area of 75 mm2 or more. The size of hematoma and the degree of dural sac compression were significantly larger in patients with symptoms needing surgical revision. Dural sac area of less than 75 mm2 in early postoperative MRI was found to be the threshold for clinical significance