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Review
. 2022 Oct;12(8):1934-1942.
doi: 10.1177/21925682221078251. Epub 2022 Feb 27.

Complications in the Elderly Population Undergoing Spinal Deformity Surgery: A Systematic Review and Meta-Analysis

Angelica Alvarez Reyes  1 , Andrew S Jack  2 , R John Hurlbert  1 , Wyatt L Ramey  3
Affiliations
Review

Complications in the Elderly Population Undergoing Spinal Deformity Surgery: A Systematic Review and Meta-Analysis

Angelica Alvarez Reyes et al. Global Spine J. 2022 Oct.

Abstract

Study design: Systematic Review and Meta-Analysis.

Objectives: The elderly have an increased risk of perioperative complications for Adult Spinal Deformity (ASD) corrections. Stratification of these perioperative complications based on risk type and specific risk factors, however, remain unclear. This paper will systematically review perioperative risk factors in the elderly undergoing ASD correction stratified by type: medical, implant-related, proximal junctional kyphosis (PJK), and need for revision surgery.

Methods: A systematic review was performed using the PRISMA guidelines. A query of PubMed was performed to identify publications pertinent to ASD in the elderly. Publications included in this review focused on patients ≥65 years old who underwent operative management for ASD to assess for risk factors of perioperative complications.

Results: A total of 734 unique citations were screened resulting in ten included articles for this review. Pooled incidence of perioperative complications included medical complications (21%), implant-related complications (16%), PJK (29%), and revision surgery (13%). Meta-analysis calculated greater preoperative PT (WMD 2.66; 95% Cl .36-4.96; P = .02), greater preoperative SVA (WMD 2.24; 95% Cl .62-3.86; P = .01), and greater postoperative SVA (WMD .97; 95% Cl .03-1.90; P = .04) to significantly correlate with development of PJK with no evidence of publication bias or concerns in study heterogeneity.

Conclusions: There is a paucity of literature describing perioperative complications in the elderly following ASD surgery. Appropriate understanding of modifiable risk factors for the development of medical and implant-related complications, proximal junctional kyphosis, and revision surgeries presents an opportunity to decrease morbidity and improve patient outcomes.

Keywords: adult spinal deformity; spinal deformity.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Schematic depicting search algorithm for systematic literature review.
Figure 2.
Figure 2.
Forest plot showing relationship between preoperative pelvic tilt and PJK.
Figure 3.
Figure 3.
Forest plot showing relationship between preoperative SVA and PJK.
Figure 4.
Figure 4.
Forest plot showing relationship between postoperative SVA and PJK.
See this image and copyright information in PMC

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