Have We Made Advancements in Optimizing Surgical Outcomes and Enhancing Recovery for Patients With High-Risk Adult Spinal Deformity Over Time? - PubMed (original) (raw)

. 2025 May 1;28(5):617-626.

doi: 10.1227/ons.0000000000001420. Epub 2024 Nov 4.

Lara Passfall 1, Peter S Tretiakov 1, Ankita Das 1, Oluwatobi O Onafowokan 1, Justin S Smith 2, Virginie Lafage 3, Renaud Lafage 3, Breton Line 4, Jeffrey Gum 5, Khaled M Kebaish 6, Khoi D Than 7, Gregory Mundis 8, Richard Hostin 9, Munish Gupta 10, Robert K Eastlack 11, Dean Chou 12, Alexa Forman 13, Bassel Diebo 14, Alan H Daniels 14, Themistocles Protopsaltis 1, D Kojo Hamilton 15, Alex Soroceanu 16, Raymarla Pinteric 4, Praveen Mummaneni 12, Han Jo Kim 17, Neel Anand 18, Christopher P Ames 12, Robert Hart 19, Douglas Burton 20, Frank J Schwab 3, Christopher Shaffrey 7, Eric O Klineberg 21, Shay Bess 4; International Spine Study Group

Affiliations

Have We Made Advancements in Optimizing Surgical Outcomes and Enhancing Recovery for Patients With High-Risk Adult Spinal Deformity Over Time?

Peter G Passias et al. Oper Neurosurg. 2025.

Abstract

Background and objectives: The spectrum of patients requiring adult spinal deformity (ASD) surgery is highly variable in baseline (BL) risk such as age, frailty, and deformity severity. Although improvements have been realized in ASD surgery over the past decade, it is unknown whether these carry over to high-risk patients. We aim to determine temporal differences in outcomes at 2 years after ASD surgery in patients stratified by BL risk.

Methods: Patients ≥18 years with complete pre- (BL) and 2-year (2Y) postoperative data from 2009 to 2018 were categorized as having undergone surgery from 2009 to 2013 [early] or from 2014 to 2018 [late]. High-risk [HR] patients met ≥2 of the criteria: (1) ++ BL pelvic incidence and lumbar lordosis or SVA by Scoliosis Research Society (SRS)-Schwab criteria, (2) elderly [≥70 years], (3) severe BL frailty, (4) high Charlson comorbidity index, (5) undergoing 3-column osteotomy, and (6) fusion of >12 levels, or >7 levels for elderly patients. Demographics, clinical outcomes, radiographic alignment targets, and complication rates were assessed by time period for high-risk patients.

Results: Of the 725 patients included, 52% (n = 377) were identified as HR. 47% (n = 338) had surgery pre-2014 [early], and 53% (n = 387) underwent surgery in 2014 or later [late]. There was a higher proportion of HR patients in Late group (56% vs 48%). Analysis by early/late status showed no significant differences in achieving improved radiographic alignment by SRS-Schwab, age-adjusted alignment goals, or global alignment and proportion proportionality by 2Y (all P > .05). Late/HR patients had significantly less poor clinical outcomes per SRS and Oswestry Disability Index (both P < .01). Late/HR patients had fewer complications (63% vs 74%, P = .025), reoperations (17% vs 30%, P = .002), and surgical infections (0.9% vs 4.3%, P = .031). Late/HR patients had lower rates of early proximal junctional kyphosis (10% vs 17%, P = .041) and proximal junctional failure (11% vs 22%, P = .003).

Conclusion: Despite operating on more high-risk patients between 2014 and 2018, surgeons effectively reduced rates of complications, mechanical failures, and reoperations, while simultaneously improving health-related quality of life.

Keywords: Adult spinal deformity; Complication rates; Frailty; High-risk patients; Postoperative outcomes; Reoperation; SRS-Schwab modifiers.

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References

    1. Passias PG, Bortz CA, Lafage V, et al. Durability of satisfactory functional outcomes following surgical adult spinal deformity correction: a 3-year survivorship analysis. Oper Neurosurg. 2020;18(2):118-125.
    1. Thomas K, Wong KH, Steelman SC, Rodriguez A. Surgical risk assessment and prevention in elderly spinal deformity patients. Geriatr Orthop Surg Rehabil. 2019;10:2151459319851681.
    1. Passias PG, Bortz C, Pierce KE, et al. Appropriate risk stratification and accounting for age-adjusted reciprocal changes in the thoracolumbar spine reduces the incidence and magnitude of distal junctional kyphosis in cervical deformity surgery. Spine. 2021;46(21):1437-1447.
    1. Staartjes VE, de Wispelaere MP, Schröder ML. Improving recovery after elective degenerative spine surgery: 5-year experience with an enhanced recovery after surgery (ERAS) protocol. Neurosurg Focus. 2019;46(4):E7.
    1. Halpin RJ, Sugrue PA, Gould RW, et al. Standardizing care for high-risk patients in spine surgery: the Northwestern high-risk spine protocol. Spine. 2010;35(25):2232-2238.

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