Introduction: Pedicle subtraction osteotomy (PSO) are challenging cases with high rates of complications and a substantial physiological burden to the patient. The literature supports the benefits of two surgeon strategies in complex cases in other surgical specialties. We evaluate the peri-operative morbidity based on the presence of a one versus two attending surgeon in PSO.
Methods: A single institution database of all PSO’s (75 cases) since 2005 was reviewed and the cohort was divided into single vs. two surgeons. Patients with staged anterior and posterior procedures were excluded. 46 patients (24 single surgeon and 22 two surgeon) underwent PSO without a staged anterior approach. Review included analysis of cases for EBL, length of surgery, length of stay, radiographic analysis, and complications.
Results: The average age of the single surgeon and two surgeon groups were 55.9 and 66.4 years, respectively. The mean number of levels of posterior spinal fusion (8.8 vs. 8.7) and spinal decompression (2.8 vs. 3.3) were comparable. The mean one vs. two surgeon EBL was 4837 vs. 1961 ml (p=0.0058) and surgical time was 7.5 vs. 4.9 hrs (p=0.0003). The average neurological complication of one surgeon vs. two surgeons was 8.3% vs. 4.5%. In the single surgeon group 6 patients had additional unplanned surgery within 30 days. In the single surgeon group 3 of 24 and in the two surgeon group none of the 22 cases were terminated extended operative time and blood loss
Conclusions: Higher intra-operative EBL and case length have been previously linked to higher rates of peri-operative complications in complex surgery. The use of two surgeons at an experienced spine deformity center decreases the operative time and EBL and may decrease the rate of neurological injury, premature case termination and return to operating room in 30 days.
Patient Care: The hope is that we will develop a surgical strategy to reduce the risk of morbidity from PSO.
Learning Objectives: Determine the reduction in peri-operative morbidity in PSO based on the presence of one versus two attending surgeon.