Morbidity and mortality in the surgical treatment of 10,242 adults with spondylolisthesis

Presented at the 2009 Joint Spine Section Meeting 

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  • 1 Department of Neurosurgery, University of Maryland Medical Center, Baltimore, Maryland;
  • 2 Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia;
  • 3 Department of Orthopedic Surgery, University of California, San Francisco, California;
  • 4 Spine Surgery Associates, PC, Chattanooga, Tennessee;
  • 5 Orthopaedic Surgery, University of Missouri, Columbia, Missouri;
  • 6 Health Sciences Centre, Winnipeg, Manitoba, Canada;
  • 7 The Royal National Orthopedic Hospital, and the Great Ormond Street Children's Hospital, London, United Kingdom;
  • 8 Arnold Palmer Children's Hospital, Orlando, Florida;
  • 9 Orthopaedics Department, Oregon Health & Science University, Portland, Oregon;
  • 10 Division of Orthopedic Surgery, Hospital for Sick Children, Toronto, Ontario, Canada;
  • 11 University of Pittsburgh Physicians, Orthopedic Surgery, Pittsburgh, Pennsylvania;
  • 12 Departments of Orthopaedic Surgery and Neurosurgery, University of Minnesota, Minneapolis;
  • 13 Twin Cities Spine Center, Minneapolis, Minnesota; and
  • 14 Hospital for Special Surgery, New York, New York
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Object

This is a retrospective review of 10,242 adults with degenerative spondylolisthesis (DS) and isthmic spondylolisthesis (IS) from the morbidity and mortality (M&M) index of the Scoliosis Research Society (SRS). This database was reviewed to assess complication incidence, and to identify factors that were associated with increased complication rates.

Methods

The SRS M&M database was queried to identify cases of DS and IS treated between 2004 and 2007. Complications were identified and analyzed based on age, surgical approach, spondylolisthesis type/grade, and history of previous surgery. Age was stratified into 2 categories: > 65 years and ≤ 65 years. Surgical approach was stratified into the following categories: decompression without fusion, anterior, anterior/posterior, posterior without instrumentation, posterior with instrumentation, and interbody fusion. Spondylolisthesis grades were divided into low-grade (Meyerding I and II) versus high-grade (Meyerding III, IV, and V) groups. Both univariate and multivariate analyses were performed.

Results

In the 10,242 cases of DS and IS reported, there were 945 complications (9.2%) in 813 patients (7.9%). The most common complications were dural tears, wound infections, implant complications, and neurological complications (range 0.7%–2.1%). The mortality rate was 0.1%. Diagnosis of DS had a significantly higher complication rate (8.5%) when compared with IS (6.6%; p = 0.002). High-grade spondylolisthesis correlated strongly with a higher complication rate (22.9% vs 8.3%, p < 0.0001). Age > 65 years was associated with a significantly higher complication rate (p = 0.02). History of previous surgery and surgical approach were not significantly associated with higher complication rates. On multivariate analysis, only the grade of spondylolisthesis (low vs high) was in the final best-fit model of factors associated with the occurrence of complications (p < 0.0001).

Conclusions

The rate of total complications for treatment of DS and IS in this series was 9.2%. The total percentage of patients with complications was 7.9%. On univariate analysis, the complication rate was significantly higher in patients with high-grade spondylolisthesis, a diagnosis of DS, and in older patients. Surgical approach and history of previous surgery were not significantly correlated with increased complication rates. On multivariate analysis, only the grade of spondylolisthesis was significantly associated with the occurrence of complications.

Abbreviations used in this paper: DS = degenerative spondylolisthesis; EMG = electromyography; IRB = Institutional Review Board; IS = isthmic spondylolisthesis; M&M = morbidity and mortality; MEP = motor evoked potential; SRS = Scoliosis Research Society; SSEP = somatosensory evoked potential; TLIF/PLIF = transforaminal lumbar interbody fusion/posterior lumbar interbody fusion.

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Contributor Notes

Current affiliation for Dr. Hamilton: University of Maryland Medical Center, Baltimore, Maryland.

Address correspondence to: Charles A. Sansur, M.D., M.H.Sc., Department of Neurosurgery, University of Maryland Medical Center, S-12-D, Baltimore, Maryland 21201. email: csansur@smail.umaryland.edu.
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