Complications in lumbar spine surgery: A retrospective analysis

Abstract

Background:Surgical treatment of adult lumbar spinal disorders is associated with a substantial risk of intraoperative and perioperative complications. There is no clearly defined medical literature on complication in lumbar spine surgery. Purpose of the study is to retrospectively evaluate intraoperative and perioperative complications who underwent various lumbar surgical procedures and to study the possible predisposing role of advanced age in increasing this rate.Materials and Methods:From 2007 to 2011 the number and type of complications were recorded and both univariate, (considering the patients’ age) and a multivariate statistical analysis was conducted in order to establish a possible predisposing role. 133 were lumbar disc hernia treated with microdiscetomy, 88 were lumbar stenosis, treated in 36 cases with only decompression, 52 with decompression and instrumentation with a maximum of 2 levels. 26 patients showed a lumbar fracture treated with percutaneous or open screw fixation. 12 showed a scoliotic or kyphotic deformity treated with decompression, fusion and osteotomies with a maximum of 7.3 levels of fusion (range 5-14). 70 were spondylolisthesis treated with 1 or more level of fusion. In 34 cases a fusion till S1 was performed.Results:Of the 338 patients who underwent surgery, 55 showed one or more complications. Type of surgical treatment (P = 0.004), open surgical approach (open P = 0.001) and operative time (P = 0.001) increased the relative risk (RR) of complication occurrence of 2.3, 3.8 and 5.1 respectively. Major complications are more often seen in complex surgical treatment for severe deformities, in revision surgery and in anterior approaches with an occurrence of 58.3%. Age greater than 65 years, despite an increased RR of perioperative complications (1.5), does not represent a predisposing risk factor to complications (P = 0.006).Conclusion:Surgical decision-making and exclusion of patients is not justified only by due to age. A systematic preoperative evaluation should always be performed in order to stratify risks and to guide decision-making for obtaining the best possible clinical results at lower risk, even for elderly patients.

Perioperative outcomes and adverse events of minimally invasive versus open posterior lumbar fusion: meta-analysis and systematic review

“…Medical comorbidities, 44 increased body mass index, 6,18 and revision surgery 39 have all been associated with increased surgical and medical complications in patients undergoing spine surgery, with minimally invasive spinal fusion being increasingly applied in these high-risk patients. 19,34,45 Although we were unable to examine for differences due to lack of reporting of specific predictor variables in the majority of studies, we do not believe it likely that this would have significantly influenced our results.…”

Incremental Hospital Cost and Length-of-Stay Associated With Treating Adverse Events Among Medicare Beneficiaries Undergoing Lumbar Spinal Fusion During Fiscal Year 2013

“…[7][8] Regardless of the reason, during fiscal year 2013, the Medicare program reimbursed hospitals over $3.6 billion for spinal fusion surgery, making total spending on spinal fusion surgery one of the three highest admission outlays in the Medicare program; along with total knee arthroplasty and congestive heart failure. 9 A number of articles have reported on mortality and selected adverse events associated with patients undergoing spinal fusion surgery [10][11][12][13][14] and other studies have examined length of stay 8,15 and unplanned readmission after spinal surgery. [16][17] However, only a few of these studies used a national sample of spinal surgery patients in the United States 8,11,[13][14][15] each adverse event.…”

Etiology of lumbar lordosis and its pathophysiology: a review of the evolution of lumbar lordosis, and the mechanics and biology of lumbar degeneration

“…89,100 However, surgical corrections of postural deformities have high complication rates. 3,152 Complications are significantly increased by advanced age, 43,58,129 medical comorbidities, 15,192 nutritional status, 106 length of fusion, 43 and extension of fusion to the sacrum. 36 The history of previous surgery has been shown to increase complication rates in some studies 68 but not others.…”