Perioperative neurologic complications during spinal fusion surgery: incidence and trends

Thirumala, Parthasarathy D.; Zhou, James J.; Natarajan, Preethi; Balzer, Jeffrey; Dixon, Edward C.; Okonkwo, David O.; Hamilton, D. Kojo

doi:10.1016/j.spinee.2017.05.020

Cited by 38 publications

(19 citation statements)

References 24 publications

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“…Given the difficult nature of spine surgery, ranging from simple lumbar decompression to advanced spinal deformity, iatrogenic neurologic injury is a rare but real complication. Recent studies have shown that the annual incidence of perioperative neurologic deficits after cervical and lumbar spine surgery increased by 54% from 0.68% in 1999 to 1.05% in 2011 (2). These neurologic complications are especially prevalent (up to 8%) in procedures requiring vertebral column resections (VCR).…”

Section: Introductionmentioning

confidence: 99%

Utilization of intraoperative neuromonitoring throughout the United States over a recent decade: an analysis of the nationwide inpatient sample

Laratta¹,

Shillingford²,

Ha³

et al. 2018

J Spine Surg

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Section: Introductionmentioning

confidence: 99%

Utilization of intraoperative neuromonitoring throughout the United States over a recent decade: an analysis of the nationwide inpatient sample

Laratta¹,

Shillingford²,

Ha³

et al. 2018

J Spine Surg

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“…1 A recent study quantifying the national incidence of postoperative neurological complications (0.82 %) showed an increasing rate of such complications (from 0.68% in 1999 to 1.05% in 2011) following anterior cervical discectomy and fusion, posterior cervical fusion, and thoracolumbar fusion. 2 Neurological complications associated with spine surgery can occur following anterior cervical discectomy and fusion, posterior cervical fusion, and thoracolumbar fusion. Myelopathic complications are also known as perioperative spinal cord injuries.…”

Section: Introductionmentioning

confidence: 99%

“…All postoperative neurological complications can result in subpar patient outcomes, complicate recovery, and increase overall health care costs. 2 Revision spine surgery is defined as a secondary surgical procedure at the same site as a previous spine surgery. No studies have analyzed the incidence of postoperative neurological complications following revision spinal surgery, which occurs more commonly than anticipated given the sheer volume of spine procedures.…”

Section: Introductionmentioning

confidence: 99%

“…No studies have analyzed the incidence of postoperative neurological complications following revision spinal surgery, which occurs more commonly than anticipated given the sheer volume of spine procedures. 2 Vascular injury, mechanical compression of the spinal cord and nerve roots, and cord and nerve root distraction have the potential to occur more frequently in revision surgery due to the presence of scar tissue and distorted anatomy. 3 With a progressively aging population and the growth of spine fusion surgeries, 4 it is important to understand the impact of postoperative neurological complications for spine surgeries in general and revision surgeries in particular.…”

Section: Introductionmentioning

confidence: 99%

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Postoperative Neurological Complications Following Revision Spine Surgery: A State Inpatient Database Analysis

2020

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Background: Postoperative neurological complications after spine surgery can result in increased mortality and morbidity. Despite the introduction of new spinal implants and surgical technology, reoperation rates have remained stable over recent years. Understanding the reasons for revision (refusion) surgery and the risk of neurological complications can assist in developing more effective screening protocols for repeat surgeries and early detection of potential neurological complications. Methods: This study was designed and conducted as a retrospective cohort study. The primary objective of this study was to evaluate whether revision spine surgery increased the risk of postoperative neurological deficits. A secondary objective of the study was to analyze whether deficits following repeat spine surgery increased morbidity and mortality. Data on revision spine procedures were extracted from the California State Inpatient Database for years 2008 to 2011. Patients who developed postoperative neurological deficits were then subdivided into causative procedure: revision anterior cervical discectomy and fusion, revision posterior cervical fusion, and revision thoracolumbar fusion. These data were then used to calculate the total incidence of postoperative neurological deficits following each type of procedure. The impact of neurological deficits on in-hospital morbidity following revision procedures was also calculated. Results: Revision procedures accounted for 5.84% of all spine procedures in a total of 7645 patients. Among these patients, 67 patients (0.88%) developed a postoperative neurological deficit with an adjusted odds ratio of 1.56 (95% CI, 1.20-2.00, P , .05). When using individuals with no neurological deficit as the reference group, the odds of morbidity were 5.3 (95% CI, 3.15-9.00, P , .05) in those who sustained neurological deficit following revision procedure. Conclusions/Clinical Relevance: This study exposes the increased risk of postoperative neurological complications in revision spine surgeries. In response, further studies are needed to evaluate the use of intraoperative neurophysiological monitoring to reduce this risk.

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“…New neurologic deficits are rare complications following spine surgery, occurring at a rate less than 1%. 1,2 The rate may be higher in specific patients with severe spinal stenosis, as one review of 114 patients demonstrated a complication rate of nearly 8%. 3 A retrospective review of 11,817 patients with new deficits revealed epidural hematoma, inadequate decompression, and acute ischemia to be the most common causes of neurologic complications, with incidences of 38%, 23%, and 19%, respectively.…”

Section: Introductionmentioning

confidence: 99%

White Cord Syndrome Causing Transient Tetraplegia After Posterior Decompression and Fusion

Busack

Eagleton

2020

TOJ

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Background: New neurologic deficits after spine surgery occur in less than 1% of cases. A particularly rare complication is white cord syndrome, a neurologic deterioration in the absence of obvious perioperative injury with concurrent hyperintense signal change on T2-weighted magnetic resonance imaging. The pathophysiologic mechanism is hypothesized to be an ischemiareperfusion injury after the decompression of a chronically ischemic cord. Case Report: A 63-year-old male underwent posterior cervical decompression and fusion for severe cervical stenosis and myelopathy. During the procedure, intraoperative neurophysiologic monitoring signals were lost. The patient developed acute postoperative tetraplegia attributed to white cord syndrome. Motor and sensory deficits improved after intravenous dexamethasone and intensive physical therapy. Conclusion: The pathophysiology of white cord syndrome is unclear, and intraoperative anesthetic management strategies to prevent this syndrome are unknown. This case serves to educate perioperative physicians to suspect this rare syndrome, encourage research into its pathophysiology, and guide clinicians in formulating therapeutic regimens.

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Perioperative neurologic complications during spinal fusion surgery: incidence and trends

Cited by 38 publications

References 24 publications

Utilization of intraoperative neuromonitoring throughout the United States over a recent decade: an analysis of the nationwide inpatient sample

Utilization of intraoperative neuromonitoring throughout the United States over a recent decade: an analysis of the nationwide inpatient sample

Postoperative Neurological Complications Following Revision Spine Surgery: A State Inpatient Database Analysis

White Cord Syndrome Causing Transient Tetraplegia After Posterior Decompression and Fusion

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