Staged Versus Simultaneous Surgery for Adult Spinal Deformity

Study Design. Systematic review and meta-analysis. Objective. To assess the safety and efficacy of staged versus same-day spinal fusion surgeries in adult spinal deformity (ASD). Background. ASD surgeries are associated with high complication rates, ranging from 10% to 40%. Among the strategies to enhance safety, staging the procedure into two smaller procedures has been evaluated as an effective alternative. Materials and Methods. A systematic literature review following PRISMA guidelines was conducted using PubMed, Cochrane, Scopus, and Embase. Studies comparing staged and same-day spinal fusion for ASD were included. Perioperative data, patient-reported outcomes (ODI, SRS), radiologic outcomes, and complication rates were analyzed. The extracted data was analyzed, and forest plots were generated to draw comparisons between the staged and same-day groups. Results. Eleven studies, including 1323 patients (541 staged, 782 same-day) were analyzed. Staged surgeries were associated with longer operative time and length of hospital stay. There was no significant difference in estimated blood loss, clinical and radiologic outcomes, or overall complication rates between groups. However, venous thromboembolism (VTE) rates were significantly higher in staged surgeries (odds ratio=4.33). In the staged group, surgical site infections were the most common complication, with a rate of 10.5%, whereas neurological complications were the most frequent group of complications in the same-day group. Conclusion. Staged surgeries for ASD result in longer operative time, length of hospital stay, and increased VTE risk but show similar efficacy in clinical and radiologic outcomes compared with same-day surgeries. Careful patient selection is crucial to balance risks and optimize outcomes in ASD surgical planning.