Postoperative Spine and Spinal Implants Instability as Complications of Treatment of the Rigid Scoliotical Deformation in Adult and Elderly Patients
Authors: Mikhaylov Dmitry , Ptashnikov Dmitry , Masevnin Sergei , Zaborovskii Nikita 
Published: April 2016

Purpose

The aim of this study was to assess the rate of complications of surgical treatment of rigid scoliotical deformation correction and stability of the fixation in adults and elderly. Material and Methods of Studies: A retrospective study of 60 patients (age 65 – 83 years) with rigid scoliotical deformation. Mean follow-up period was 5 years (2–8 years). Retrospectively we evaluated the deformation according to SRS-Schwab Based on HQROL Classification of Adult Deformity studying in all cases long cassette standing anteroposterior and lateral radiographs. Type L,A,L,P for 19 patients; type L,C,M,VP for 21 patients; type S,B,M,VP for 13 patients; type S,C,H,P and T,A,M,P for 7 patients equally. The main indications for surgery were static and biomechanical spinal disorders with pain (100%) and neurological syndrome (74.3%). All patients were divided into 2 groups based on the extent of surgical treatment and the severity of concomitant somatic pathology. The first group include 28 patients with high risk of cardiovascular complications who were undergone the correction of deformation by transpedicular screw fixation, multilevel SPO and TLIF. The second group include 32 patients with the correction of deformation by multilevel fixation, SPO, TLIF and PSO despite the possible risks of cardiovascular complications. Results and Discussion: In the first group in 13 cases we did not achieve a full postoperative restoration of the sagittal & coronal balance. In 6 patients the displacement of the screws was found in the postoperative period. In 5 cases the metal construction was broken. In 3 cases the terminal vertebras fractures with the displacement of the screws marked one year after the operation. These complications led to a loss of correction, which required a reoperation in all cases. In the second group a full restoration of the sagittal & coronal balance was achieved. In 1 case there was a screw migration due to osteoporosis. The rate of complications of the deformity correction in the first group was statistically significant higher than in the second group ( p < 0.01).

Conclusions

The study showed that the transpedicular fixation during the correction of a rigid deformation in patients requires the full restoration of sagittal balance. The surgical treatment of scoliotical deformation with PSO, TLIF and SPO showed an improvement of the long-term results. The aim of this study was to assess the rate of complications of surgical treatment of rigid scoliotical deformation correction and stability of the fixation in adults and elderly. A retrospective study of 60 patients (age 65 – 83 years) with rigid scoliotical deformation. The study showed that the transpedicular fixation during the correction of a rigid deformation in patients requires the full restoration of sagittal balance. The surgical treatment of scoliotical deformation with PSO, TLIF and SPO showed an improvement of the long-term results.