Table 5.

Some measures to avoid common complications after adult spinal deformity surgery

Systemic complications

Cardiac

Prevent excessive bleeding, apply less invasive surgery

Assess cardiac functions meticulously

Pulmonary emboli and DVT

Use compression stockings

Renal

Avoid excessive bleeding and fluid replacement

Frailty

Prehabilitation for frail patients

Delirium

Treat depression, early mobilization after surgery, psychological support

Less corticosteroids, decrease delirium-inducing medications

Neurologic complications

Intraoperative neuromonitoring

Use microscope during decompression

Avoid screw malposition by intraoperative fluoroscopy, navigation, EMG monitoring

Infection

Shorten the operation time, provide less bleeding

Weight loss against high body mass index

Good regulation of diabetes

Repair dural tears, use dural sealants

Avoid using steroids

Replace blood in case of low hemoglobin level

Apply minimally invasive surgeries

Preoperative antiseptic dressing

Prophylactic antibiotics

Intraoperative irrigation of the operation site with saline and antibiotics

Implant failure

Screw loosening, pseudoarthrosis

Manage osteoporosis before surgery

Use appropriate amount of bone grafts

Achieve a good sagittal balance

Rod-screw breakage

Use multi-rod constructs

Proximal junctional kyphosis

Provide sagittal balance

Augment cranial level with prophylactic vertebroplasty

Use hooks, wires, or polyethylene tethers at the upper end

Avoid excessive SVA corrections and excessive lumbar lordosis

Avoid soft-tissue and facet joint damage at the UIV

Good selection of end vertebra

Try less rigid fixations, flexible rods, hybrid constructs

Distal junctional kyphosis, caudal ASD

Use iliac screws to increase the strength on caudal level

Add interbody fusion to L5-S1 level

DVT: Deep vein thrombosis, SVA: Sagittal vertical axis, ASD: Adjacent segment disease, UIV: Upper instrumented vertebra