Take Risks of Complications From ASD Surgery Seriously

Honest reporting from a good database on adult spinal deformity surgery paints an eye-opening picture of complications

Take Risks of Complications From ASD Surgery Seriously

What’s the Claim?

Sometimes, prognostic information about the behavior of an operation — even in the context of a case series — can be as informative as a comparative trial.

A single-center, registry-based case series of about 100 patients who had large adult spinal deformity surgery (average of 10 levels fused, one-third of the procedures were revisions, 14% had 3-column osteotomy) found:

  • 26% underwent unplanned reoperation
  • 71% had a complication (25% defined as major), and nearly 40% developed proximal junctional kyphosis
  • Only 33% of the patients reported a clinically important improvement in outcomes scores at 1 year
    • Fewer than half achieved that at 5 years

The complications tended to appear early — for example, 21% of the reoperations were within the first 2 years, and 5% occurred between 2 and 5 years — but nearly 20% of the complications occurred after 2 years.

How’s It Stack Up?