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Review
. 2022 Oct 1;47(19):1337-1350.
doi: 10.1097/BRS.0000000000004435. Epub 2022 Jul 13.

Failure in Adult Spinal Deformity Surgery: A Comprehensive Review of Current Rates, Mechanisms, and Prevention Strategies

John F Burke  1 , Justin K Scheer  1 , Darryl Lau  2 , Michael M Safaee  1 , Austin Lui  3 , Sonya Jha  4 , Chloe Jedwood  4 , Isabelle Thapar  4 , Bethany Belfield  4 , Nami Nobahar  4 , Albert J Wang  1 , Elaina J Wang  5 , Tony Catalan  1 , Diana Chang  6 , Marissa Fury  1 , Patrick Maloney  1 , Henry E Aryan  7 , Justin S Smith  8 , Aaron J Clark  1 , Christopher P Ames  1
Affiliations
Review

Failure in Adult Spinal Deformity Surgery: A Comprehensive Review of Current Rates, Mechanisms, and Prevention Strategies

John F Burke et al. Spine (Phila Pa 1976). .

Abstract

Study design: Literature review.

Objective: The aim of this review is to summarize recent literature on adult spinal deformity (ASD) treatment failure as well as prevention strategies for these failure modes.

Summary of background data: There is substantial evidence that ASD surgery can provide significant clinical benefits to patients. The volume of ASD surgery is increasing, and significantly more complex procedures are being performed, especially in the aging population with multiple comorbidities. Although there is potential for significant improvements in pain and disability with ASD surgery, these procedures continue to be associated with major complications and even outright failure.

Methods: A systematic search of the PubMed database was performed for articles relevant to failure after ASD surgery. Institutional review board approval was not needed.

Results: Failure and the potential need for revision surgery generally fall into 1 of 4 well-defined phenotypes: clinical failure, radiographic failure, the need for reoperation, and lack of cost-effectiveness. Revision surgery rates remain relatively high, challenging the overall cost-effectiveness of these procedures.

Conclusion: By consolidating the key evidence regarding failure, further research and innovation may be stimulated with the goal of significantly improving the safety and cost-effectiveness of ASD surgery.

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Conflict of interest statement

The authors report no conflicts of interest.

References

    1. Lenke LG, Betz RR, Harms J, et al. Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis. JBJS. 2001;83:1169–81.
    1. Smith JS, Shaffrey CI, Berven S, et al. Improvement of back pain with operative and nonoperative treatment in adults with scoliosis. Neurosurgery. 2009;65:86–93; discussion 93–4.
    1. Roussouly P, Gollogly S, Berthonnaud E, et al. Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine. 2005;30:346–53.
    1. Bridwell KH, Baldus C, Berven S, et al. Changes in radiographic and clinical outcomes with primary treatment adult spinal deformity surgeries from two years to three- to five-years follow-up. Spine (Phila Pa 1976). 2010;35:1849–54.
    1. Blondel B, Schwab F, Ungar B, et al. Impact of magnitude and percentage of global sagittal plane correction on health-related quality of life at 2-years follow-up. Neurosurgery. 2012;71:341–8; discussion 348.

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