Male patients with adult spinal deformity: sex differences in demographics, radiography, and complications

Purpose: This study aimed to investigate sex-related differences in demographics, radiography, and perioperative complications in adult spinal deformity (ASD) surgeries.

Methods: This retrospective cohort, single-center study enrolled patients who underwent long-instrumented fusion from the thoracic spine to the ilium for ASD, with a minimum follow-up of 2 years. The incidence of preoperative comorbidities, perioperative complications, and postoperative mechanical complications was analyzed.

Results: Of the 323 patients, ASD was more common in females (85.8%). The T-score in female patients was lower than that in male patients (-1.6 ± 1.1 vs.- 0.8 ± 1.0, p = 0.02). Male patients demonstrated lower rates of degenerative kyphoscoliosis (83.4% vs. 65.2%, p = 0.004) but higher rates of neuromuscular disease (7.6% vs. 21.7%, p = 0.003) than female patients. Male patients exhibited higher prevalence of cardiovascular disease (4.0% vs. 13.5%, p = 0.034) and hemodialysis (2.5% vs. 10.8%, p = 0.035). Additionally, male patients had a higher Charlson Comorbidity Index than female patients (0.8 ± 1.1 vs. 1.4 ± 1.1, p = 0.001). Moreover, male patients showed higher perioperative complications in surgical site infection (5.1% vs. 15.2%, p = 0.018). However, the incidence of proximal junctional failure (43.3% vs. 39.1%, p = 0.595) and rod fracture (27.8% vs. 26.1%, p = 0.81) was not different.

Conclusions: Male patients with ASD demonstrated frequent pathology of neuromuscular disease, preoperative comorbidities, and surgical site infection, necessitating careful preoperative checkups and intraoperative care.