Late Complications and Adverse Events in Adult Deformity Surgery: A Narrative Review of Event Types, Prevalence, and Information Gaps

Abstract

Study DesignLiterature review.ObjectivesThe purpose of this paper is to provide a narrative review of late complications in adult deformity surgery, including infection, pseudarthrosis and junctional pathology after deformity correction. This review aims to highlight limitations of current management and identify potential areas of improvement and further study.MethodsWe identified common challenges of late complications in adult spinal deformity surgery and performed a directed literature review to summarize the current management and issues encountered in these adverse events. Through consensus, we highlighted the knowledge gaps in the current literature and suggested areas of interest for further study to improve understanding and management of these conditions.ResultsA summary is provided with detailed review of late complications that include infection, pseudarthrosis, junctional pathology, and late decompensation after deformity correction. Important consideration to choosing the appropriate upper and lower instrumented levels, obtaining desired coronal and sagittal alignment, preserving the adjacent ligamentous and muscular structures, obtaining solid arthrodesis, recognizing and optimizing patients for surgery, appropriate pre and post-operative protocols, and appropriately defining normal and pathological parameters.ConclusionsRecognizing appropriate predictor and outcome variables are important for identifying factors, modifiable and fixed, that may be important to make a clinically important difference in outcomes in the surgical treatment of adult spinal deformity. Future studies to reduce late complications are important to improve value and outcome in adult spinal deformity surgery.

Keywords: PJK; adult spinal deformity; infection; pseudoarthrosis; surgical complications.

Figure 1.

A 55-year-old female with diffusive idiopathic skeletal hyperostosis (a-c). She underwent pedicle subtraction osteotomy at L1 and instrumentation from T8 to L4 (d). At 7-month follow-up, loss of lordosis and retrolisthesis was observed at L4/5 (e, f). Positive sagittal imbalance, L4/5 disc breakdown, and L5 compression fracture was observed at 10 years follow-up (g, h). With pedicle subtraction osteotomy at L4, and pelvic fixation via S2 alar-iliac screws, the sagittal balance was well restored (i). Some loss of correction was observed at 1-year follow-up (j), but the patient remains happy clinically (k).

Figure 2.

(A) 54-year-old female with degenerative lumbar kyphosis (A); In a local hospital, she underwent TLIF at L3/4 and L4/5, and then her posterior instrumentation was removed 1 year after the initial surgery for unknown reason (B); 1 year later, she underwent revision surgery in another hospital due to progressive lumbar kyphosis (C); 2 years after this revision, she presented with distal instrumentation failure and fixed positive sagittal imbalance (D); During the second revision surgery, we strengthened the distal fixation via bilateral dual S2 alar-iliac screws, and the sagittal alignment was restored and well maintained (E, F).