Impact of Concurrent Spine Surgery on Multilevel Spinal Fusion in the Management of Adult Degenerative Scoliosis

Introduction: Adult Spinal Deformity (ASD) involves age-related lumbar degeneration and curvature. Treatment begins with therapy and pain management, but severe cases may need surgery. This study examines the impact of concurrent spinal surgeries with fusion on surgical outcomes.

Methods: This retrospective study at the University of Texas Southwestern reviewed adult deformity surgery patients who underwent long-segment thoracolumbar fusion (>3 levels) from 2016 to 2021. We analyzed demographics, frailty indices, and perioperative data using Wilcoxon rank sum, chi-square, and regression analyses in RStudio.

Results: A total of 235 patients were analyzed, with 187 undergoing concurrent surgery and 48 undergoing fusion-only procedures. The concurrent surgery group had more females (61% vs. 85%) and a lower median BMI (27.0 vs. 29.0). The median Cobb angle was similar between groups (25 vs. 27 degrees). No significant differences were observed in osteoporosis, osteopenia, BMI, ASA score, and mFI-11. The median anesthesia duration was 282 minutes for concurrent surgery and 273 minutes for fusion-only (p = 0.2). Estimated blood loss was (1,315 mL vs. 1,500 mL, p = 0.15). Univariate analysis indicated lower odds of needing intraoperative platelet (OR = 0.37, p = 0.010) and cryoprecipitate transfusions (OR = 0.26, p = 0.014) in concurrent surgery. Multivariate analysis revealed no significant associations of concurrent surgery with anesthesia time, surgical complications, revision rates, ICU length of stay (LOS), hospital LOS, or 30-day readmissions. Levels fused and mFI-11 were significant predictors of ICU and hospital LOS, with each additional level fused increasing LOS by 0.24 days, and higher frailty index increasing ICU LOS by 8.9 days and hospital LOS by 0.45 days.

Conclusion : The approach to ASD should be individualized, without significant differences, concurrent procedures should be considered if they relieve symptoms, improve stability, and enhance quality of life, ensuring they benefit the patient and minimize unnecessary surgeries.