Impact of surgical approach on complication rates after elective spinal fusion (≥3 levels) for adult spine deformity

Abstract

Background: While there are variations in techniques and surgical approaches to spinal fusion, there is not a defined consensus on a recommended surgical approach. The aim of this study is to determine if there was a difference in intra- and post-operative complication rates between different surgical approaches after elective spinal fusion (≥3 levels) for adult spine deformity.

Methods: The medical records of 443 adult spine deformity patients undergoing elective spinal fusion (≥3) at a major academic institution from 2005 to 2015 were reviewed. We identified 96 (21.7%) anterior only, 225 (50.8%) posterior only, and 122 (27.5%) combined anterior/posterior approaches taken for spinal fusion (anterior: n=96; posterior: n=225). Patient demographics, comorbidities, anatomical location, and complication rates were collected for each patient. The primary outcome investigated in this study was the rate of intra- and post-operative complications.

Results: Patient demographics and comorbidities were similar between all groups. The posterior approach had significantly higher EBL (P<0.0001) and number of PRBC blood transfusions (P<0.002), while the combined approach had a higher operative time (P<0.0001). The posterior approach had a significantly higher rate of intraoperative durotomies than anterior and combined (anterior: 0% vs. posterior: 11.1% vs. combined: 4.1%, P<0.0001). There was no significant difference in the rate 30-day readmissions between the cohorts (anterior: 10.4% vs. posterior: 12.8% vs. combined: 13.1%, P=0.80).

Conclusions: Our study suggests that posterior approaches to spinal fusion may lead to a higher incidence of complications compared to anterior or combined anterior/posterior approaches.

Keywords: Adult spinal deformity; outcomes; spinal fusion; surgical approach.