Late Complications and Adverse Events in Adult Deformity Surgery: A Narrative Review of Event Types, Prevalence, and Information Gaps.

Abstract

Study DesignLiterature review.ObjectivesThe purpose of this paper is to provide a narrative review of late complications in adult deformity surgery, including infection, pseudarthrosis and junctional pathology after deformity correction. This review aims to highlight limitations of current management and identify potential areas of improvement and further study.MethodsWe identified common challenges of late complications in adult spinal deformity surgery and performed a directed literature review to summarize the current management and issues encountered in these adverse events. Through consensus, we highlighted the knowledge gaps in the current literature and suggested areas of interest for further study to improve understanding and management of these conditions.ResultsA summary is provided with detailed review of late complications that include infection, pseudarthrosis, junctional pathology, and late decompensation after deformity correction. Important consideration to choosing the appropriate upper and lower instrumented levels, obtaining desired coronal and sagittal alignment, preserving the adjacent ligamentous and muscular structures, obtaining solid arthrodesis, recognizing and optimizing patients for surgery, appropriate pre and post-operative protocols, and appropriately defining normal and pathological parameters.ConclusionsRecognizing appropriate predictor and outcome variables are important for identifying factors, modifiable and fixed, that may be important to make a clinically important difference in outcomes in the surgical treatment of adult spinal deformity. Future studies to reduce late complications are important to improve value and outcome in adult spinal deformity surgery.