Instrumentation complication rates following spine surgery: a report from the Scoliosis Research Society (SRS) morbidity and mortality database

Jamal N. Shillingford, Joseph L. Laratta, Nana O. Sarpong, Rami G. Alrabaa, Meghan K. Cerpa, Ronald A. Lehman, Lawrence G. Lenke, Charla R. Fischer


Background: Objective of this study is to evaluate demographics, risk factors, and incidence of instrumentation related complications (IRC) in spinal surgeries from 2009–2012. The Scoliosis Research Society (SRS) morbidity and mortality (M&M) database has tremendous value in orthopaedic surgery. SRS gathers surgeon-reported complications, including instrumentation failure, visual complications, neurological deficits, infections, and death. Limited literature exists on the incidence of perioperative instrumentation complications in deformity surgery. We utilized the SRS database to evaluate demographics, risk factors, and incidence of IRC in spinal surgeries from 2009–2012.
Methods: The SRS M&M database was queried for IRC in patients undergoing surgery for scoliosis, spondylolisthesis, and kyphosis from 2009–2012. Demographics, comorbidities, diagnoses, curve magnitude, and intraoperative characteristics were analyzed. Intraoperative characteristics included surgical approach, performance of fusion or osteotomy, operative times, blood loss, instrumentation used, and documented instrumentation complication.
Results: A total of 167,972 patients were identified, including 311 IRC. The overall IRC rate was 0.19% (18.5 per 10,000 patients), which decreased significantly from 2009–2012 (0.37% vs. 0.19%, P<0.001). The mean age of patients with IRC was 38.5±25.5 years. Most common comorbidities included hypertension (23.5%), pulmonary disease (13.5%), diabetes (10.6%), smoking (8.7%), and vascular disease (7.1%). IRC occurred in 206 (66.2%) patients with scoliosis, 58 (18.6%) with spondylolisthesis, and 45 (14.5%) with kyphosis. Compared to patients with spondylolisthesis, patients with kyphosis (0.27% vs. 0.11%, P<0.001) and scoliosis (0.21% vs. 0.11%, P<0.001), experienced significantly more IRC. IRC included implant failure (23.3%), migration (28.3%), and malpositioned implants (48.6%). New perioperative neurologic deficits were reported in 146 (46.9%) patients, and 84 (27%) of these implants were removed.
Conclusions: IRC occur in approximately 18.5 per 10,000 deformity patients, with a rate significantly higher in patients with kyphosis. The potentially avoidable occurrence of implant malpositioning represents nearly 50% of these complications. Closer attention to posterior bony anatomy, improved intraoperative imaging with utilization of navigation or robotic guidance may decrease these complications.