A new study by a multi-center team of researchers has offered evidence that, despite there being potential for improving outcomes, particularly when it comes to pain and disability, major complications and outright failure continue to be associated with adult spinal deformity surgeries.
New Study Tackles Adult Spinal Deformity Revision Rates
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Secondary#adultspinaldeformity#complications#innovations
In the study, “Failure in Adult Spinal Deformity Surgery: A Comprehensive Review of Current Rates, Mechanisms, and Prevention Strategies,” the researchers summarize recent literature on adult spinal deformity treatment failure and ways to prevent it.
“There is substantial evidence that adult spinal deformity surgery can provide significant clinical benefits to patients. The volume of adult spinal deformity surgery is increasing, and significantly more complex procedures are being performed, especially in the aging population with multiple comorbidities,” the researchers wrote.
Through a systematic search of PubMed databases, the researchers found that failure and the potential need for revision surgery fall into 1 of 4 phenotypes: clinical failure, radiographic failure, the need for reoperation and lack of cost-effectiveness.
High revision surgery rates are challenging the overall cost-effectiveness of these surgeries.
“By consolidating the key evidence regarding failure, further research and innovation may be stimulated with the goal of significantly improving the safety and cost-effectiveness of adult spinal deformity surgery,” they wrote.
The findings are published in the October 1, 2022, issue of the journal Spine. Study authors included John F. Burke, M.D., Ph.D., Justin K. Scheer, M.D., Michael M. Safaee, M.D., Albert J. Wang, B.S., Tony Catalan, B.S., Marissa Fury, B.S., Patrick Maloney, M.D., Aaron J. Clark, M.D., Ph.D. and Christopher P. Ames, M.D., all of the department of neurological surgery at the University of California, San Francisco.
Darryl Lau, M.D., of the department of neurological surgery at New York University in New York, Austin Lui, B.S., of Touro University in Vallejo, California, Elaina J. Wang, B.S. of Brown University, Diana Chang, B.S., at the University of California, San Francisco School of Medicine, Henry E. Aryan, M.D., of Sierra Pacific Orthopedics in Fresno, California, and Justin S. Smith, M.D., Ph.D., of the University of Virginia in Charlottesville, Virgina also contributed to the study. And so did Sonya Jha, B.SC., Chloe Jedwood, B.Sc, Isabelle Thapar, B.Sc., Bethany Belfield, B.Sc., and Nami Nobahar, B.Sc., all of the University of California, Berkely, California.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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