The Morbidity of Anterior Exposure for Spinal Deformity in Adults: An Analysis of Patient-Based Outcomes and Complications in 112 Consecutive Cases

Summary: A multicenter analysis of approach related outcomes and complications in 112 consecutive adult deformity patients was performed. Poor outcomes in Appearance or Self-image were more related to the anterior approach than poor outcomes in Pain or Function. 86% of patients reported mild to no pain but 26% were somewhat or very unhappy with appearance. The paramedian approach was associated with slightly less pain and functional disturbance. Approach related complications occurred in 18%, including 3 ventral hernia repairs.

Purpose: Determine the impact of anterior exposures on pain, function, and self-image; and the prevalence of approach-related complications.

Methods: A multi-center analysis of 112 consecutive adult deformity patients (18-89 yrs, mean f/u 28.5 months) having anterior exposure to 4 or more vertebrae. Patients grouped: Thoracic (T), Thoracolumbar (T/L), Lumbar Oblique (LO) or Lumbar Paramedian (LP). A modified SRS-30 was prospectively administered, and complications recorded. Statistical analysis: ANOVA and chi-square.

Results: Distribution: T=8, T/L=62, LO=21, LP=16. For Pain domain, 85% of patients reported mild to no pain. "Moderate to severe" pain occurred in 15% of T/L, 28.6% of LO, and no LP(p Overall, 18% of patients (18% T/L, 19% LO and 25% LP)experienced a major approach-related complication and 12% required approach related re-operation (3 ventral hernia repair). Most common patient concern: abdominal bulging in 11% (13 T/L, 5 LO and 13 LP).

Conclusion: This is the first prospective multi-center analysis of anterior approach-specific patient outcomes. The data indicate T/L and LO approaches result in significant impacts on all domains, while somewhat less pain and functional disturbance was seen among LP patients. Patients with a poor outcome for Appearance or Self-image are significantly more likely to relate it directly to the anterior approach (p<0 .001).