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Spine surgery complications

Epidural hematomas, cerebrospinal fluid fistula, and spinal infections are challenging postoperative complications following vertebro-spinal procedures.

Surgical site infections (SSI) are common spine surgery complications.

Most descriptions of spine surgery morbidity and mortality in the literature are retrospective. Emerging prospective analyses of adverse events (AEs) demonstrate significantly higher rates, suggesting underreporting in retrospective and prospective studies that do not include AEs as a targeted outcome.

see Spinal epidural hematoma.

see Spinal cerebrospinal fluid leakage

see Subdural hematoma

see Spinal infection

see Venous thromboembolism.

see Pneumocephalus.

see Spinal epidural hematoma

459 patients who were divided into 5 groups: group 1, patients with cervical degenerative disease treated with posterior decompression; group 2, patients with cervical degenerative disease treated with instrumentation for spinal fusion; group 3, patients with thoracolumbar degenerative disease treated with instrumentation for spinal fusion; group 4, patients with lumbar spinal stenosis treated with posterior decompression; and group 5, patients with lumbar spondylolisthesis treated with 1-level posterior lumbar interbody fusion. A deep venous thrombosis and pulmonary embolism (PE) screening was performed for all patients. Binomial logistic regression analysis was used to assess the association of risk factors.

The incidence of VTE was 2.8%, 3.4%, 10.8%, 12.5%, and 10.1% in groups 1, 2, 3, 4, and 5, respectively. Female sex, advanced age, spinal level, and neurological deficits, were all risk factors. Cervical spinal surgery in particular had an associated low risk. In patients with PE, 3 of the 4 had no deep venous thrombosis, indicating that screening for PE is also needed in high-risk patients.

The prevalence of venous thromboembolism (VTE) after elective spinal surgery was different in each group 1).

Major spinal surgery in adult patients is often associated with significant intraoperative blood loss.

In spine surgery, the incidence of postoperative wound infection is 0.7 to 16% 2) 3).

Although incidence rates are low, adverse events of spinal procedures substantially increase the cost of care. Charges for patients experiencing Deep venous thrombosis (DVT), PE, and surgical site infection (SSI) increased in a study by factors ranging from 1.8 to 4.3 times those for patients without such complications across 5 common spinal and orthopedic procedures. Cost projections by health care providers will need to incorporate expected costs of added care for patients experiencing such complications, assuming that the cost burden of such events continues to shift from payers to providers 4).

Gelfoamis widely used in spine surgery and its complication is rare. Gelfoam has been used to control the bleeding and prevent scar adhesion when used after laminectomy as an effective interposing membrane

Yoshioka K, Murakami H, Demura S, Kato S, Tsuchiya H. Prevalence and risk factors for development of venous thromboembolism after degenerative spinal surgery. Spine (Phila Pa 1976). 2015 Mar 1;40(5):E301-6. doi: 10.1097/BRS.0000000000000727. PubMed PMID: 25494320.
O'Toole J E, Eichholz K M, Fessler R G. Surgical site infection rates after minimally invasive spinal surgery. J Neurosurg Spine. 2009;11(4):471–476.
Schimmel J J, Horsting P P, de Kleuver M, Wonders G, van Limbeek J. Risk factors for deep surgical site infections after spinal fusion. Eur Spine J. 2010;19(10):1711–1719
Daniels AH, Kawaguchi S, Contag AG, Rastegar F, Waagmeester G, Anderson PA, Arthur M, Hart RA. Hospital charges associated with “never events”: comparison of anterior cervical discectomy and fusion, posterior lumbar interbody fusion, and lumbar laminectomy to total joint arthroplasty. J Neurosurg Spine. 2016 Aug;25(2):165-9. doi: 10.3171/2015.11.SPINE15776. Epub 2016 Mar 18. PubMed PMID: 26989978.
spine_surgery_complications.txt · Last modified: 2018/12/29 16:57 by administrador