One-stage Posterior Spinal Osteotomy in Severe Spinal Deformities: A Total of 147 Cases.

STUDY DESIGN: This is a retrospective study. OBJECTIVES: The treatment of severe spinal deformities is still a difficult surgical challenge. It is generally significant to identify the related complications performed to a consecutive series of patients with severe spinal deformity and managed by 1-stage posterior spinal osteotomy. SUMMARY OF BACKGROUND DATA: We investigated data from 147 consecutive patients (75 males and 72 females) with severe deformity and managed by Smith-Petersen osteotomy, pedicle subtraction osteotomy, or vertebral column resection between years 2006 and 2012 with >2-year follow-up. Mean age was 21.2 (range, 14-51 y) years at operation. MATERIALS AND METHODS: The patients underwent standing anteroposterior and lateral radiography before and after scoliosis surgery. Age, sex, diagnosis, surgical approach and centrum, all the related complications, treatment, and preoperative and postoperative Cobb angle in the coronal and sagittal planes were recorded at final follow-up. RESULTS: There were 17 (11.6%) cases with complications in 147 patients, including spinal cord-related complications in 7 cases (4.8%), superior mesenteric artery syndrome in 5 cases (3.4%), broken rod and unstable screw hat in 3 cases (2.0%), and infection in 2 cases (1.4%). Among the 17 cases, 15 cases recovered completely and 2 cases recovered partially. CONCLUSIONS: The total complication rate of severe spinal deformity after 1-stage posterior spinal osteotomy without fusion was about 11.6%. Except for the major complication of neurological deficit, spine surgeon should also pay more attention on other related complications, especially superior mesenteric artery syndrome. Large-scale and long-term follow-up was warranted to find out more subjective complication rates. LEVEL OF EVIDENCE: Level IV-prognostic study (see the guidelines for a complete description of levels of evidence).

Risk assessment and decision-making for patients undergoing orthopedic surgery.

PURPOSE: Physical and operative severity score for the enumeration of mortality and morbidity (POSSUM) scoring system was designed to predict the postoperative morbidity and mortality mainly in general surgery. The purpose of this study was to assess the value of POSSUM scoring system in predicting outcomes of patients undergoing orthopedic surgery, and to do some modifications to make the system more accurate in predicting postoperative complication rates. METHODS: This is a retrospective clinical study involving 779 patients between April 1, 2009 and September 1, 2010. The postoperative complication rates were predicted by POSSUM, and then compared with the actual morbidity. Logistic regression was taken to improve the POSSUM equation. RESULTS: In the 779 cases, the predicted morbidity was 27.2% (212 cases) by POSSUM, while the actual morbidity is 8.3% (65 cases). CONCLUSION: POSSUM excessively predicted the morbidity of patients undergoing orthopedic surgery, and it could be more accurate with appropriate modification. Of all risk factors, echocardiography ejection fraction showed a close relationship with postoperative complications.