AIM To determine the incidence and risk factors for mechanical complications(MC) after surgical correction of adult spinal deformity(ASD) with osteotomy.METHODS A retrospective study was performed. Inclusion criteria: Surgical correction of ASD using osteotomy; male or female; > 20 years old; follow-up ≥ 24 mo or revision. The MC of spine and spinal instrumentation were studied separately. Risk analysis included assessment of the association between more than 50 different characteristics(demographic,clinical,radiographic,and instrumentation) with different types of MC.RESULTS The medical records of 94 operations in 88 subjects were analyzed: Female(68%),mean age 58.6(SD,12.7) years. Cumulative incidence of MC at 2 year follow-up was 43.6%. Of these,78% required revision(P 100 mm,lumbar lordosis(LL) 75 mm; operative correction: SVA > 75 mm,LL > 30°,thoracic kyphosis > 25°,and pelvic tilt > 9°; a fall; pseudarthrosis; and(3) device and surgical technique: use of previously implanted instrumentation; use of domino and/or parallel connectors; type of osteotomy(PSO vs SPO) if preoperative SVA 60°; and fixation to sacrum/pelvis.CONCLUSION Risk of MC after surgical correction of ASD is substantial. To decrease this risk over-and/or insufficient correction of the sagittal imbalance should be avoided.
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