Analysis of complications with staged surgery for less invasive treatment of adult spinal deformity

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World Neurosurg


BACKGROUND: Spinal deformity surgery is often invasive and lengthy. Staging surgery over separate operative days may reduce complications. Staging is often used in minimally invasive treatment of adult spinal deformity (ASD).

OBJECTIVE: To investigate the impact of staging on complication rates between hybrid (HYB; minimally invasive interbody with open posterior screw and rod fixation) and circumferential minimally invasive surgery (cMIS; minimally invasive interbody and screw/rod placement) procedures in ASD patients.

METHODS: A multicenter ASD patient database was reviewed. Patients who underwent staging (at least 3 levels) and 2 years of follow-up were analyzed. A total of 99 patients underwent staging; 53 cMIS and 46 HYB surgeries. Propensity matching for levels fused resulted in 19 patients in each group. Intra- and perioperative complications were assessed.

RESULTS: Three HYB but no cMIS intraoperative complications occurred. More HYB patients had perioperative complications than cMIS patients. Neurologic complications were more frequent in HYB vs. cMIS. Other complications did not differ significantly. Thirty-day re-operations were higher with cMIS than HYB, but there was no difference in reoperation rate at long-term follow-up. cMIS patients had greater improvement in Oswestry Disability Index. There was no difference in complications between staged vs. unstaged cMIS surgeries.

CONCLUSION: cMIS staged surgeries appear safer than HYB staged surgeries, and equally safe to cMIS unstaged surgeries. Perioperative complications were significantly higher for HYB staged surgeries. HYB surgeries may have better results when done in a single setting, while cMIS surgeries can be done in one or two stages depending on surgeon preference.

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ePub ahead of print