Effects of age on perioperative complications of extensive multilevel thoracolumbar spinal fusion surgery

Cloyd, Jordan M.; Acosta, Frank L.; Cloyd, Colleen; Ames, Christopher P.

doi:10.3171/2009.10.spine08741

Cited by 58 publications

(41 citation statements)

References 31 publications

(42 reference statements)

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“…Radiographic fusion was also achieved in 91%. These results are consistent with other studies on lateral interbody fusion [7][8][9][10][11]. …”

Section: Discussionsupporting

confidence: 93%

The Reliability of Neuromonitoring to Detect Neurologic Injury during Lateral Interbody Fusion

Lee¹,

Gertsch²,

Taylor³

et al. 2015

Spine Res

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Summary of background data: Lateral interbody fusion is a minimally invasive procedure that is gaining popularity. Hip flexion weakness has been noted postoperatively but the cause of the weakness still remains unknown. The objective of this study is to evaluate if conventional neuromonitoring with electromyography (EMG), somatosensory (SSEP), and motor evoked potentials (MEP) allows surgeons to detect potential nerve injuries that standard EMG monitoring may miss. Method:Patients undergoing lateral interbody fusion were monitored with standard electromyography and conventional neuromonitoring with electromyography, somatosensory evoked potentials, and motor evoke potentials. All consecutive lateral interbody fusion patients who had a minimum 2-year follow-up were included in the analysis. Data gathered included VAS, ODI, as well as radiographic fusion assessment. Hip flexion weakness was considered significant if the muscle grade decreased by 2 or more.Results: 113 subjects were recruited for this study. Pain scores (visual analog scores) decreased from 6.4 ± 2.1 pre-operatively to 3.2 ± 2.35 post-operatively at 2 years (p<0.0001). Functional scores (Oswestry Disability Index) improved by 30% from 41.5 ± 14.6 pre-operatively to 29.2 ± 17.5 post-operatively at 2-year follow-up (p<0.0001). 3 cases of significant hip flexion weakness were noted postoperatively. Electromyography from both systems and somatosensory evoked potenatials from conventional neuromonitoring were unchanged during these cases. Changes were noted on motor evoked potenatials in all three of these cases. This suggests that the hip flexion weakness may be due to a neurologic injury that is occurring during the case despite normal electromyography readings.Discussion: Electromyography is a reliable monitoring tool during lateral intrerbody fusion surgery with a reliability of 97.5% (110/113). However, there is the potential of neurologic injury despite normal electromyograpy and somatorsensory evoked potentials during the case. Physicians need to be aware of this and patients should be counseled appropriately.

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“…Radiographic fusion was also achieved in 91%. These results are consistent with other studies on lateral interbody fusion [7][8][9][10][11]. …”

Section: Discussionsupporting

confidence: 93%

The Reliability of Neuromonitoring to Detect Neurologic Injury during Lateral Interbody Fusion

Lee¹,

Gertsch²,

Taylor³

et al. 2015

Spine Res

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“…The phenomena of ''older'' age being associated with greater rates of complication has been described in many surgical subspecialties including general surgery [11], orthopedics [12], and neurosurgery (spine surgery [13] and cranial surgery [14]). Although the OR of increased complication was highest in patients older than 65 years, what is interesting about our findings is the increase in complication rates starting at 40 years, a relatively young age.…”

Section: Discussionmentioning

confidence: 99%

Independent predictors of complication following surgery for spinal metastasis

et al. 2013

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Purpose Surgery for spinal metastasis is often associated with significant morbidity. Despite a number of preoperative scoring systems/scales and identified variables that have been reported to predict complication risk, clinical studies that directly evaluate this issue using multivariate analysis are scarce. The goal of our study was to assess independent predictors of complication after surgery for spinal metastasis. Methods We queried electronic medical records to identify a consecutive population of adult patients who underwent surgery for spinal metastasis for the period June 2005 through June 2011. Utilizing multivariate logistic regression, we assessed independent predictors of perioperative and postoperative adverse events. Results A total of 106 patients were included in the final analysis. Overall complication rate was 21.7 %. Independent predictors for higher rates of complication were age greater than 40 years [40-65 years had odds ratio (OR) 1.91, 95 % confidence interval (CI) 1.02-16.78 and [65 years had OR 5.17, 95 % CI 1.54-29.81] and metastatic lesions involving three or more contiguous levels of the spine (OR 2.76, 95 % CI 1.09-9.61). Conclusions Patients older than 40 years or patients who have metastatic lesions involving three or more contiguous vertebral levels appear to be at higher risk for complication. Patients older than 65 years have the greatest likelihood of complication.

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“…9,12 We report an unplanned reoperation rate of 25% in patients undergoing pelvic fixation (8.6% for S2AI screws vs 35% for iliac bolts). Considering reoperation as a failure in a Kaplan-Meier survival model, we found a failure-free rate of 96.6% at 6 months, 87.0% at 12 months, 79.6% at 18 months, and 73.5% at 24 months, overall for all patients.…”

Section: Failure-free Ratementioning

confidence: 93%

Unplanned reoperation after lumbopelvic fixation with S-2 alar-iliac screws or iliac bolts

Mazur¹,

Ravindra²,

Schmidt³

et al. 2015

SPI

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OBJECT S-2 alar-iliac (S2AI) screws are an attractive alternative to conventional fixation with iliac bolts because they are lower profile, require less muscle dissection, and have greater pullout strength. Few studies, however, compare outcomes between these techniques. METHODS The authors conducted a retrospective cohort study of consecutive adult patients at a single institution from December 2009 to March 2012 who underwent lumbopelvic fixation using S2AI screws or iliac bolts. Medical records were reviewed for patients with clinical failure, defined as an unplanned reoperation because of instrumentation failure and/or wound-related complications. Univariate, multivariate, and survival analyses were used to compare patients who required reoperation with those who did not. Method of pelvic fixation was the main predictor variable of interest, and the authors adjusted for potential confounding risk factors. RESULTS Of the 60 patients included, 23 received S2AI screws. Seventeen patients (28%) underwent an osteotomy. The mean follow-up was 22 months. A Kaplan-Meier survival model was used to evaluate the time to reoperation from the initial placement of lumbopelvic instrumentation. The failure-free rate was 96.6% at 6 months, 87.0% at 1 year, and 73.5% at 2 years. Reoperation was more common in patients with iliac bolts than in those with S2AI screws (13 vs 2; p = 0.031). Univariate analysis identified potential risk factors for unplanned reoperation, including use of iliac bolts (p = 0.031), absence of L5–S1 interbody graft (p = 0.048), previous lumbar fusion (p = 0.034), and pathology other than degenerative disease or scoliosis (p = 0.034). After adjusting for other risk factors, multivariate analysis revealed that the use of S2AI screws (OR 8.1 [1.5–73.5]; p = 0.030) was the only independent predictor for preventing unplanned reoperation. CONCLUSIONS Both S2AI screws and iliac bolts were effective at improving fusion rates at the lumbosacral junction. The use of S2AI screws, however, was independently associated with fewer unplanned reoperations for wound-related complications and instrumentation failures than the use of iliac bolts.

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Effects of age on perioperative complications of extensive multilevel thoracolumbar spinal fusion surgery

Cited by 58 publications

References 31 publications

The Reliability of Neuromonitoring to Detect Neurologic Injury during Lateral Interbody Fusion

The Reliability of Neuromonitoring to Detect Neurologic Injury during Lateral Interbody Fusion

Independent predictors of complication following surgery for spinal metastasis

Unplanned reoperation after lumbopelvic fixation with S-2 alar-iliac screws or iliac bolts

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