Complications and health-related quality of life following lumbosacral hemivertebra resection and short segmental fusion: a retrospective cohort study

Abstract

BACKGROUND CONTEXT

Previous literature has provided descriptions of postoperative complications. However, these studies have included heterogeneous cohorts of hemivertebra patients undergoing different surgical methods and addressing deformities at various locations.

PURPOSE

To assess independent risk factors for complications following lumbosacral hemivertebra (LSHV) resection and to further explored the potential association between complications and health-related quality of life (HRQOL).

DESIGN

Retrospective cohort study.

PATIENT SAMPLE

We retrospectively analyzed consecutive patients who underwent LSHV resection and short segment fusion at our institution between 2010 and 2022.

OUTCOME MEASURE

In the current study, the outcome measure were complications and HRQOL.

METHODS

Between 2010 and 2022, a total of 64 consecutive patients with LSHV underwent hemivertebra resection. The diagnostic criteria for LSHV were delineated that the hemivertebra resides caudal to L5 and beyond. Electronic patient record and radiographic data were reviewed retrospectively in our electronic database. According to complications, the patients were divided into with and without complications, and further stratified as neurological, mechanical, and infectious complications. HRQOL outcomes were collected preoperatively, 3 months postoperatively, and at last follow-up using the Scoliosis Research Society-22 (SRS-22) questionnaire. Multivariate logistic regression models were used to determine independent risk factors affecting complications.

RESULTS

A total of 64 patients were enrolled in this study for at least 2-year follow-up. The mean follow-up was 7.3±4.2 years. In the coronal plane, the mean main curve was corrected from 27.3° preoperatively to 8.0° postoperatively, and 9.3° at last follow-up. Global spine balance was significantly improved after surgery, and kept stable during the follow-up. In all, 18 complications were recorded in 15 (23.4%) patients. In the multivariate logistic regression model, 3 independent risk factors for complication were screened out, including age (OR=1.16, 95% CI 1.01–1.34, p=.042), anterior reconstruction (OR=3.40, 95% CI 1.03–11.2, p=.045), and preoperative CB (OR=1.06, 95% CI 1.00–1.12, p=.036). The mean SRS-22 total and domain scores for the entire cohort showed improvement at last follow-up. However, in the noncomplication group, the improvements in SRS-22 scores were more substantial.

CONCLUSION

Postoperative neurological and mechanical complications are common medical events following LSHV resection. The age, anterior column reconstruction, and preoperative coronal balance were the independent risk factors. Compared to the noncomplication group, the improvements in HRQOL are blunted in the complication group.