• John F Burke, Justin K Scheer, Darryl Lau, Michael M Safaee, Austin Lui, Sonya Jha, Chloe Jedwood, Isabelle Thapar, Bethany Belfield, Nami Nobahar, Albert J Wang, Elaina J Wang, Tony Catalan, Diana Chang, Marissa Fury, Patrick Maloney, Henry E Aryan, Justin S Smith, Aaron J Clark, and Christopher P Ames.
• Department of Neurological Surgery, University of California, San Francisco, CA.
• Spine. 2022 Oct 1; 47 (19): 1337-1350.

Study DesignLiterature review.ObjectiveThe aim of this review is to summarize recent literature on adult spinal deformity (ASD) treatment failure as well as prevention strategies for these failure modes.Summary Of Background DataThere is substantial evidence that ASD surgery can provide significant clinical benefits to patients. The volume of ASD surgery is increasing, and significantly more complex procedures are being performed, especially in the aging population with multiple comorbidities. Although there is potential for significant improvements in pain and disability with ASD surgery, these procedures continue to be associated with major complications and even outright failure.MethodsA systematic search of the PubMed database was performed for articles relevant to failure after ASD surgery. Institutional review board approval was not needed.ResultsFailure and the potential need for revision surgery generally fall into 1 of 4 well-defined phenotypes: clinical failure, radiographic failure, the need for reoperation, and lack of cost-effectiveness. Revision surgery rates remain relatively high, challenging the overall cost-effectiveness of these procedures.ConclusionBy consolidating the key evidence regarding failure, further research and innovation may be stimulated with the goal of significantly improving the safety and cost-effectiveness of ASD surgery.Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

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