Predictors of reoperation for spinal disorders in Chiari malformation patients with prior surgical decompression

Oluwatobi O Onafowokan; Ankita Das; Jamshaid M Mir; Haddy Alas; Tyler K Williamson; Kimberly Mcfarland; Jeffrey Varghese; Sara Naessig; Bailey Imbo; Lara Passfall; Oscar Krol; Peter Tretiakov; Rachel Joujon-Roche; Pooja Dave; Kevin Moattari; Stephane Owusu-Sarpong; Jordan Lebovic; Shaleen Vira; Bassel Diebo; Virginie Lafage; Peter Gust Passias

doi:10.4103/jcvjs.jcvjs_140_23

Predictors of reoperation for spinal disorders in Chiari malformation patients with prior surgical decompression

J Craniovertebr Junction Spine. 2023 Oct-Dec;14(4):336-340. doi: 10.4103/jcvjs.jcvjs_140_23. Epub 2023 Nov 29.

Authors

Oluwatobi O Onafowokan¹, Ankita Das¹, Jamshaid M Mir¹, Haddy Alas¹, Tyler K Williamson¹, Kimberly Mcfarland¹, Jeffrey Varghese², Sara Naessig¹, Bailey Imbo¹, Lara Passfall¹, Oscar Krol¹, Peter Tretiakov¹, Rachel Joujon-Roche¹, Pooja Dave¹, Kevin Moattari¹, Stephane Owusu-Sarpong¹, Jordan Lebovic¹, Shaleen Vira³, Bassel Diebo⁴, Virginie Lafage⁵, Peter Gust Passias¹

Affiliations

¹ Department of Orthopedic and Neurological Surgery, NYU Langone Orthopaedic Hospital, New York, USA.
² Twin Cities Spine Centre, Minneapolis, MN, USA.
³ Department of Orthopedic Surgery, Banner Health, Phoenix, AZ, USA.
⁴ Department of Orthopedic Surgery, Warren Alpert School of Medicine, Brown University, RI, USA.
⁵ Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, USA.

Abstract

Background: Chiari malformation (CM) is a cluster of related developmental anomalies of the posterior fossa ranging from asymptomatic to fatal. Cranial and spinal decompression can help alleviate symptoms of increased cerebrospinal fluid pressure and correct spinal deformity. As surgical intervention for CM increases in frequency, understanding predictors of reoperation may help optimize neurosurgical planning.

Materials and methods: This was a retrospective analysis of the prospectively collected Healthcare Cost and Utilization Project's California State Inpatient Database years 2004-2011. Chiari malformation Types 1-4 (queried with ICD-9 CM codes) with associated spinal pathologies undergoing stand-alone spinal decompression (queried with ICD-9 CM procedure codes) were included. Cranial decompressions were excluded.

Results: One thousand four hundred and forty-six patients (29.28 years, 55.6% of females) were included. Fifty-eight patients (4.01%) required reoperation (67 reoperations). Patients aged 40-50 years had the most reoperations (11); however, patients aged 15-20 years had a significantly higher reoperation rate than all other groups (15.5% vs. 8.2%, P = 0.048). Female gender was significantly associated with reoperation (67.2% vs. 55.6%, P = 0.006). Medical comorbidities associated with reoperation included chronic lung disease (19% vs. 6.9%, P < 0.001), iron deficiency anemia (10.3% vs. 4.1%, P = 0.024), and renal failure (3.4% vs. 0.9%, P = 0.05). Associated significant cluster anomalies included spina bifida (48.3% vs. 34.8%, P = 0.035), tethered cord syndrome (6.9% vs. 2.1%, P = 0.015), syringomyelia (12.1% vs. 5.9%, P = 0.054), hydrocephalus (37.9% vs. 17.7%, P < 0.001), scoliosis (13.8% vs. 6.4%, P = 0.028), and ventricular septal defect (6.9% vs. 2.3%, P = 0.026).

Conclusions: Multiple medical and CM-specific comorbidities were associated with reoperation. Addressing them, where possible, may aid in improving CM surgery outcomes.

Keywords: Chiari malformation; decompression; predictors; reoperation.