Multiple failed previous surgeries should not be a barrier to further operations

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According to a study presented at NASS, revision surgery in selected adult patients with spinal deformity is associated with a good outcome and an acceptable rate of complications.

Virginie Lafage, New York University Hospital for Joint Diseases, New York, USA, who was presenting the study on behalf of Khaled Kebaish (The Johns Hopkins University, Baltimore, USA), said that revision deformity surgery was associated with more complications and worse outcomes compared with primary surgery. However, she explained that in their study, Kebaish et al hypothesized that although revision surgery may have a higher incidence of complications, patients undergoing revision surgery may experience a comparable gain in functional outcome to those undergoing primary surgery.

Lafage explained that the study was a multicentre study in which 317 consecutive patients were enrolled by eight different centres. Of the patients enrolled, 187 met the inclusion criteria—age ≥18 years who needed primary or revision surgery for correction of adult spinal deformity. There were 113 primary surgery patients and 53 revision patients (with an average of two prior surgeries, ranging one to 14).

There were no significant differences in the overall rate of major complications (15% for primary vs. 22% for revision surgery; p=0.25), but the rate of deep infection was significantly higher in revision patients compared with primary patients (54% vs. 37%, respectively; p=0.025).

Additionally, there were no significant differences in the rate of minor complications (34% for primary vs. 37% for minor complications; p=0.76) or in the rate of reoperation (12.3% for primary vs. 14.5% for revision; p=0.27) between groups.  

Lafage also reported that surgery in both groups led to marked improvements in the Scoliosis Research Society (SRS) 22 score and in the Oswestry Disability Index (ODI) score, but said that the SRS scores were higher in the primary surgery group and that the ODI scores were lower in this group compared with the revision surgery group. She concluded: “Multiple failed previous spinal surgeries should not by themselves be a contraindication for performing another corrective procedure. Revision surgery in selected adult spinal deformity patients can achieve good outcomes with an acceptable rate of complications.”

 

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