1553. Dual Surgeon Operations for Long Segment Posterior Fusion Leads to Reduced Morbidity

Authors: Teddy Earl Kim, MD; Alexander Powers, MD; John Frino, MD; Eloise Joubert, BS (Winston Salem, NC)

Introduction:

Surgical correction of large deformities is associated with high degree of morbidity. Previous reports show benefit of dual attending surgeon presence in reducing operative duration and blood loss in scoliosis surgery. We performed dual surgeon operations for neuromuscular scoliosis (NMS), congenital scoliosis (CS), adolescent idiopathic scoliosis (AIS) and adult degenerative scoliosis (ADS) and present a series of over 100 cases to show the benefit for dual surgeon operation for large deformity correction.

Methods:

Patient list was generated for dual surgeon operations performed by attending neurosurgeon and orthopedic surgeon between 2012 and 2017. There were 149 cases, of which cases for long segment fusion (greater than 6 levels of instrumentation) were included for analysis leaving 111 patients for review. Patients were evaluated for pre- and post-operative deformity measurements, operative duration, estimated blood loss (EBL), readmission rate and complications.

Results:

Of 111 patients included in the study, 60/111 (54%) had NMS, 31/111 (27.9%) AIS, 12/111 (10.8%) CS, and 8/111 (7.2%) ADS. Most significant improvement in coronal curvature was noted in NMS (47.5 degrees) followed by AIS (39.6 degrees), followed by ADS (24.9 degrees) and CS (24.3 degrees). Most significant improvement in sagittal imbalance was noted in ADS (30.6mm). Mean length of operation was longest in ADS (306min), followed by NMS (245min), followed by CS (243min), followed by AIS (212min). EBL was largest in ADS (1450cc), followed by NMS (742cc), followed by CS (721cc), followed by AIS (516cc). Complications were reported in 24/111 (21.6%) patients with infection being most common followed by pseudoarthrosis.

Conclusion:

We present first report of a single institution experience with dual surgeon operation for long segment fusion in the treatment of both adult and pediatric scoliosis. We demonstrate comparable outcomes in EBL and length of operation with previously reported publications in dual surgeon operations for scoliosis.