Study Design: Retrospective review of a prospectively collected multicenter database. Objectives: To evaluate the evolution of surgical treatment strategies, complications, and patient-reported outcomes for adult spinal deformity (ASD) patients. Summary of Background Data: ASD surgery is associated with high complication rates. Evolving treatment strategies may reduce these risks. Methods: Adult patients undergoing ASD surgery from 2009 to 2016 were analyzed (n = 905). Preoperative and surgical parameters were compared across years. Subgroup analysis of 436 patients with minimum two-year follow-up was also performed. Results: From 2009 to 2016, there was a significant increase in the mean preoperative age (52 to 63.1, p <.001), body mass index (26.3 to 32.2, p =.003), Charlson Comorbidity index (1.4 to 2.2, p <.001), rate of previous spine surgery (39.8% to 53.1%, p =.01), and baseline disability (visual analog scale [VAS] back and leg pain) scores (p <.01), Oswestry Disability Index, and 22-item Scoliosis Research Society Questionnaire scores (p <.001). Preoperative Schwab sagittal alignment modifiers and overall surgical invasiveness index were similar across time. Three-column osteotomy utilization decreased from 36% in 2011 to 16.7% in 2016. Lateral lumbar interbody fusion increased from 6.4% to 24.1% (p =.004), anterior lumbar interbody fusion decreased from 22.9% to 16.7% (p =.043), and transforaminal lumbar interbody fusion/posterior lumbar interbody fusion utilization remained similar (p =.448). Use of recombinant human bone morphogenetic protein-2 (rhBMP-2) in 2012 was 84.6%, declined to 58% in 2013, and rebounded to 76.3% in 2016 (p =.006). Tranexamic acid use increased rapidly from 2009 to 2016 (13.3% to 48.6%, p <.001). Two-year follow-up sagittal vertical axis, pelvic tilt, pelvic incidence–lumbar lordosis, and maximum Cobb angles were similar across years. Intraoperative complications decreased from 33% in 2010 to 9.3% in 2016 (p <.001). Perioperative (<30 days, <90 days) complications peaked in 2010 (42.7%, 46%) and decreased by 2016 (24.1%, p <.001; 29.6%, p =.007). The overall complication rate decreased from 73.2% in 2008–2014 patients to 62.6% in 2015–2016 patients (p =.03). Two-year health-related quality of life outcomes did not significantly differ across the years (p >.05). Conclusions: From 2009 to 2016, despite an increasingly elderly, medically compromised, and obese patient population, complication rates decreased. Evolving strategies may result in improved treatment of ASD patients. Level of Evidence: Level IV.
- Adult spinal deformity
- Health-related quality of life
- Three-column osteotomy
ASJC Scopus subject areas
- Orthopedics and Sports Medicine