Complication Management of Spine Deformity Surgery: Overview of Surgical Complications of Adult Spinal Deformity Surgery

Adult spinal deformity (ASD) surgery is associated with a high rate of complications due to the complex nature of the procedures and the advanced age and comorbidity of the patient population. This chapter provides an overview of the incidence, classification, and risk factors of surgical complications in ASD. Complications are categorized by type (surgical vs. systemic), timing (intraoperative to late postoperative), and severity (including Clavien–Dindo and ISSG-AO classifications). Patient-specific factors such as age, frailty, and bone mineral density, as well as surgical factors, such as invasiveness and alignment correction, contribute to complication risk. Predictive models including the Global Alignment and Proportion (GAP) score and frailty indices (mFI-11, mFI-5, and mASD-FI) offer valuable tools for risk stratification and surgical planning. Understanding and mitigating these risks through individualized alignment goals, careful patient selection, and comprehensive perioperative management are essential to improve surgical outcomes in ASD.