Planned staging for posterior surgical correction of multi-planar spinal deformities, does it differ?

Abstract

Background Data: Complex spine surgery is a challenging and difficult procedure. It has to be performed by senior spine surgeons to correct complex deformities. This type of corrective procedures can be challenging and commonly requires long operations, with subsequent higher rates of complications when compared to ordinary spine operations. The literature has few data comparing the outcomes of single-stage posterior operation versus staged posterior correction of complex spine surgery. Single-session surgery entails the classical correction of complex deformities via a single-stage posterior operation, while staged posterior surgery means dividing the surgical maneuver into two posterior sessions with the final correction being performed in the second session. Studying the clinical and radiological data is extremely helpful in determining the safety and effectiveness of staging long spinal operations for the correction of complex spinal deformities. Purpose: This study aims to compare perioperative and 1-year outcomes of single-stage posterior correction versus staged posterior surgical correction of complex spine deformities. Study Design: Prospective cohort study. Patients and Methods: Patient sample: A total of 22 patients with complex spinal deformity were recruited for this study (12, one-stage operation; 10, two-stage operation). Outcome measures: Perioperative and one-year postoperative clinical and radiological data were collected and analyzed. Data included operative time, blood loss, immediate postoperative Cobb angle, one-year Cobb angle and percentage of correction of the deformity, one-year loss of correction, and one-year complication rate. Results There were no significant differences between the 2 groups as regards immediate postoperative Cobb angle (33.0±15.0, one-stage operation; 30.8±14.8, two-stage operation; P=0.771); percentage of correction within one year (60.7±12.0%, one-stage operation; 60.1±16.1%, two-stage operation; P=0.974); one-year loss of correction % (7.8±3.2, one-stage operation; 6.3±3.3, two-stage operation; P=0.238); one-year complication rate (83.3%, one-stage operation; 60%, two-stage operation; P=0.348). However, statistically significant difference was found between the 2 groups in terms of the total blood loss (3366.7±499.7 ml, one-stage operation; 4035.0±887.0 ml two-stage operation; P=0.038) and total operative time (353.3±46.8 min, one-stage operation; 486.5±131.5 min two-stage operation; P=0.011). Neurological complications (16.7%) and malpositioned screws (25%) were reported only in one-stage operations (however, this was statistically nonsignificant when comparing total complications in both groups (=1.833 and 2.895, resp.; P=0.481 and 0.221, resp.). Neurological complications were directly related to operative time (415±35.4 min) (P=0.033), average blood loss (4100±141.4 ml) (P=0.014), and postoperative hemoglobin (Hb) (5.5±0.7 g) (P=0.002). Conclusion: Our data suggest that staging complex spine procedures should be considered in any lengthy spinal operations (≥ 415 min) and operations with excessive blood loss (≥ 4100 ml) to protect against and prevent irreversible neurological insults. (2019ESJ186)

Keywords

• spinal deformities
• complex spine
• neurological deficits
• kyphoscoliosis