Personalized Spine Surgery in Adult Deformity: Reoperation Rates and Mechanical Complications Following Customized Planning and Interbody Implant Use

Abstract

Study Design: Retrospective cohort study. Objectives: Prior studies have shown that adult spinal deformity (ASD) patients undergoing revision surgery due to mechanical complications had less radiographic improvement and worsening patient-reported outcomes scores. The combination of customized 3D planning and personalized implants has been shown to contribute to improved achievement of alignment goals. This study aimed to determine whether such improved correction also results in a correspondingly lower revision surgery rate due to mechanical complications. Methods: Pre- and postoperative radiographic alignment measures, including lumbar lordosis (LL), distal lumbar lordosis (DLL), pelvic incidence (PI) – LL mismatch, and L1 pelvic angle (L1PA), as well as data on mechanical complications leading to reoperation were collected on 115 ASD patients with personalized interbody implants and minimum 2-year follow-up. This cohort was statistically compared to a multicenter dataset (ISSG) of 997 ASD patients treated using stock devices and using the same reoperation classifications. Results: Postoperatively achieved alignment measures correlated significantly with their respective preoperative alignment goals, with the following average offsets from plan: 2.4° LL, −0.2° DLL, −2.4° PI-LL, 0.3° L1PA. Compared to the ISSG cohort that utilized stock interbody implants, the cohort utilizing 3D preoperative planning and personalized interbody implants resulted in significantly fewer revisions for mechanical complications up to 2 years postoperatively: 5/115 (4.3%) vs 166/997 (16.6%), P < 0.001. Conclusions: These findings suggest that achieving planned alignment targets with personalized interbody devices is associated with reduced revision surgery for mechanical complications, a result which may have positive implications for improved patient outcomes and reduced cost.