J Korean Orthop Assoc.  2016 Feb;51(1):40-47. 10.4055/jkoa.2016.51.1.40.

Complications and Risk Factors of Surgery for Adult Spine Deformity

• Kim WJ
• Cha YH

• KMID: 2154347
• DOI: http://doi.org/10.4055/jkoa.2016.51.1.40

Abstract

Demand for surgical management of adult spine deformity has increased due to a recent increase in the elder population, development of surgical techniques, and increased desire for a better quality of life. More surgeries led to more and various complications. Complications of surgery for adult spine deformity have been reported from 37% to 53% depending on the types of disease, cause, and patient. This rate is higher than complications from general spine surgeries. Complications of surgery for adult spine deformity include; infection, excessive bleeding, nerve injury, pseudarthrosis, adjacent segment disease, and iliac screw complication. Factors influencing these complications include; old age, diabetes, steroid use, and osteoporosis. Proximal junctional kyphosis (PJK) is an abnormal kyphosis at the proximal level of the instrument after spine deformity surgery. Risk factors for PJK include; injury of paravertebral muscles and posterior ligament complex, over- and under-correction of coronal sagittal imbalance, age older than 55 years, and osteoporosis. There is a high risk of unexpected complications during surgery for adult spine deformity. Patients with degenerative spine sagittal imbalance are more prevalent in Korea than in Western countries. They tend to be old, have underlying diseases and osteoporosis, making them susceptible to complications related to instrumentation. Postoperative satisfaction tends to be low thus surgeons need to take care when selecting surgical methods and fusion level.

Keyword

adult spine deformity; junctional problem; proximal junctional kyphosis; iliac screw; pseudarthrosis

MeSH Terms

Adult*
Congenital Abnormalities*
Hemorrhage
Humans
Korea
Kyphosis
Ligaments
Muscles
Osteoporosis
Pseudarthrosis
Quality of Life
Risk Factors*
Spine*

Figure

• 

  Figure 1 (A) A 67-year-old female who presented with adult spinal deformity underwent osteotomy and posterior instrumentation. (B) Three years later we found pseudarthrosis and rod breakage on the osteotomy site.

• 

  Figure 2 (A) A 59-year-old female who presented with adult spinal deformity underwent osteotomy and posterior instrumentation. Two years later, follow-up X-ray showed rod breakage and the osteotomy site appeared to be show union. We decided to the instrument. (B) After the removal surgery, the patient complained of pain and stooping. (C) Postoperative X-ray showed pseudarthrosis and a junctional fracture.

• 

  Figure 3 (A) A 72-year-old female who presented with severe sagittal imbalance underwent posterior instrumentation. Imbalance was undercorrected. (B) Proximal junctional fracture and proximal junctional kyphosis occurred as a complication at postoperative 3 months.

• 

  Figure 4 (A) A 72-year-old female who presented with adult spinal scoliosis underwent osteotomy and posterior instrumentation. (B) Eighteen months later, an iliac screw was pulled out and a skin irritation wound problem occurred.

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