Original ArticleIncreased 30-Day Complication Rates Associated with Laminectomy in 874 Adult Patients with Spinal Deformity Undergoing Elective Spinal Fusion: A Single Institutional Study
Introduction
Adult spinal deformity is a debilitating disease that affects both physical function and overall quality of life.1, 2 Most patients present with concomitant structural misalignment and stenosis. Accordingly, decompression with fusion may be necessary to remove the compressive elements on the neural tissue, while also achieving realignment of the spine.3
The efficacy of decompressive surgery in treating spinal stenosis is well documented.4, 5 Multiple studies have shown that decompression for spinal stenosis is associated with greater improvement of back pain, leg pain, and overall disability compared with conservative therapy.6, 7, 8 Furthermore, it has been reported that decompression in addition to fusion is superior to fusion alone in patients with spondylolisthesis and documented radiculopathy.9, 10 However, decompression in patients with degenerative spinal pathologies is associated with increased operative time and perioperative and postoperative complications. There is a paucity of studies comparing the postoperative complication profiles in patients undergoing fusion alone versus decompression with fusion for treatment of adult spinal deformities. The aim of this study was to compare intraoperative and 30-day postoperative complication rates between patients with spinal deformity undergoing spinal fusion with and without laminectomy.
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Materials and Methods
In this retrospective study, we reviewed the medical records of 874 adult (≥18 years old) patients with spinal deformity who underwent elective spinal fusion at a major academic institution during the period 2005–2015. Institutional review board approval was obtained before initiation of the study. The preponderance of patients had degenerative scoliosis, with 270 patients (30.9%) with idiopathic deformity. Of patients, 374 (42.8%) underwent a laminectomy in addition to spinal fusion, and 500
Results
This study included 874 adult patients (no-laminectomy cohort, n = 500; laminectomy cohort, n = 374). There were no significant differences between cohorts in age (no-laminectomy cohort 63.2 years ± 12.1 vs. laminectomy cohort 64.6 years ± 11.5; P = 0.07), sex (no-laminectomy cohort 39.7% male vs. laminectomy cohort 39.1% male; P = 0.89), or body mass index (no-laminectomy cohort 28.6 kg/m2 ± 6.6 vs. laminectomy cohort 29.2 kg/m2 ± 6.6; P = 0.14) (Table 1). There were no significant differences
Discussion
In this retrospective study, we suggest that decompression with fusion may be associated with higher intraoperative and 30-day complication rates compared with fusion alone. Increased complication rates after combined decompression with fusion have been reported previously in the literature. In a randomized controlled trial of 228 patients, Forsth et al.11 showed that patients undergoing combined laminectomy and spinal fusion experienced greater estimated blood loss, operative time, and length
Conclusions
This study suggests that patients undergoing spinal fusion with laminectomy may have higher complication rates than patients undergoing spinal fusion alone. Further studies are necessary to corroborate our findings.
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Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.