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This research investigates how metabolic syndrome affects recovery and outcomes in adult spinal deformity surgery.

March 30, 2026World Neurosurgery0 citationsOpen Access

Are We Missing the Bigger Comorbidity Picture? Metabolic Syndrome Worsens Alignment and Increases Mechanical Complications Following Adult Spinal Deformity Surgery

ASAdvith Sarikonda HJHarsh Jain IYIyan Younus

Key Points

This research investigates how metabolic syndrome affects recovery and outcomes in adult spinal deformity surgery.
Conducted a retrospective analysis of patients undergoing ASD surgery from 2010-2023 with 2-year follow-up
Defined metabolic syndrome as comprising hypertension, diabetes, and BMI≥30 kg/m2
Evaluated alignment, complications, and PROMs using multivariable regression analysis controlling for confounding factors.
Patients with metabolic syndrome showed significantly higher rates of postoperative alignment issues (OR:5.2)
Metabolic syndrome was associated with increased mechanical complications like rod fractures (OR:4.0)
No significant impact of metabolic syndrome on medical complications or PROMs was found.

Abstract

Metabolic syndrome may influence recovery after complex spine surgery. In patients undergoing adult spinal deformity (ASD) surgery, we evaluated the relationship between metabolic syndrome and: 1) postoperative alignment, 2) complications, and 3) patient-reported outcome measures (PROMs). A retrospective analysis (2010-23, 2-year-follow-up) was conducted of patients undergoing ASD surgery. Metabolic syndrome was defined as concurrent hypertension, diabetes, and body mass index (BMI)≥30 kg/m2. The primary outcomes were 1) alignment, evaluated as sagittal vertical axis (SVA) cm > 5cm and L1-pelvic angle (L1PA) within 5° of target, or coronal vertical axis (CVA) >3 cm, and 2) medical and mechanical complications. Secondary outcomes were 2-year Oswestry Disability Index (ODI) scores. Multivariable regression controlled for age, sex, prior fusion, operative time, and preoperative alignment/PROMs. Of 288 patients undergoing ASD surgery, 31 (11%) had metabolic syndrome. Patients with metabolic syndrome were significantly older (71±8 vs. 62±18 years, p5 cm(OR:5.2, 95%CI:1.4-19.0). Medical Complications:Metabolic syndrome was not associated with medical complications (all p >0.05). Mechanical Complications: Metabolic syndrome was independently associated with rod fractures/pseudarthrosis (OR:4.0, 95%CI: 1.6-10.1, p=0.003). 2-Year PROMs: 2-year PROMs were similar between the cohorts (all p>0.05). Preoperative metabolic syndrome was independently associated with postoperative sagittal malalignment and rod fractures/pseudarthrosis. Continued awareness of metabolic syndrome may enable surgeons to holistically address the syndrome preoperatively.

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