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  • Peak Timing and Associated Risk Factors for Specific Complications Following Adult Spinal Deformity (ASD) are Identifiable; A Guide for Surgeons and Patients

    Final Number:

    Shay Bess MD; Breton G. Line BSME; Virginie Lafage PhD; Christopher P. Ames MD; Oheneba Boachie-Adjei MD; Douglas C. Burton MD; Robert Hart MD; Behrooz A. Akbarnia MD; Eric Klineberg MD; Gregory Mundis MD; Richard A. Hostin MD; Frank Schwab MD, PhD; Christopher I. Shaffrey MD, FACS; Justin S. Smith MD PhD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2014 Annual Meeting

    Introduction: ASD surgery complication rates rank the highest of surgical specialties. Total complication rates have been reported, however little data exists for the timing and risk factors associated with specific complications. Purpose: evaluate the peak timing and risk factors for specific complications in a prospective, consecutive ASD cohort at minimum 2yr follow-up.

    Methods: Prospective analysis of complications following ASD surgery. Inclusion criteria: ASD, age = 18yrs, spinal fusion =4 levels, and minimum 2yr follow up. Complications divided into major and minor, then further divided into operative, implant failure, infectious, neurological, proximal junctional kyphosis (PJK), return to OR, and wound complications. Peak timing of complications identified and rank order best fit modeling for complication risk factors created using multivariate analysis (MARS) at delineated time points (T=0, <3, 3-6, 6-12, 12-24 and >24 months.

    Results: 199 patients, mean follow-up 44.3 months (range 23.3-60.3) met inclusion criteria. There were 350 total complications (214 minor, 136 major). Minor complications peaked at t<3 months, major complications had bi-modal peaks at T=0 and 12-24 months. Neurological complications and PJK had bimodal peaks at <3 and 12-24 and <3 and 6-12 months, respectively. Implant failures peaked at >24 months. Rank order best fit MARS variables for major complications at T=0 was rhBMP-2 interbody dose/level, BMI and EBL, and at 12-24 months was SVA. MARS risk factors for minor complications at <3 months were rhBMP-2 posterior dose/level, EBL, total posterior fusion levels, and maximal scoliosis. The only risk factor for neurological complications at <3 months was total osteotomies; no risk factors were identified at 12-24 months. Risk factors for implant failures at >24 months were 3-column osteotomies, SVA and EBL.

    Conclusions: Risk factors for the peak timing of specific complications following ASD surgery are identifiable. Surgeons should be aware of complication timing and risk factors to improve patient care.

    Patient Care: The results of this study will improve patient care by alerting surgeons to the timing of complications which can aid in patient education as well as the potential risk factors for complications allowing for areas of improvement to reduce the complication rates.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Identify the peak timing of major and minor complications following ASD surgery and 2) identify risk factors for complications


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