Complications in spine surgery

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>The overall incidence of complications or adverse events in spinal surgery is unknown. Both prospective and retrospective analyses have been performed, but the results have not been critically assessed. Procedures for different regions of the spine (cervical and thoracolumbar) and the incidence of complications for each have been reported but not compared. Authors of previous reports have concentrated on complications in terms of their incidence relevant to healthcare providers: medical versus surgical etiology and the relevance of perioperative complications to perioperative events. Few authors have assessed complication incidence from the patient's perspective. In this report the authors summarize the spine surgery complications literature and address the effect of study design on reported complication incidence.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>A systematic evidence-based review was completed to identify within the published literature complication rates in spinal surgery. The MEDLINE database was queried using the key words “spine surgery” and “complications.” This initial search revealed more than 700 articles, which were further limited through an exclusion process. Each abstract was reviewed and papers were obtained. The authors gathered 105 relevant articles detailing 80 thoracolumbar and 25 cervical studies. Among the 105 articles were 84 retrospective studies and 21 prospective studies. The authors evaluated the study designs and compared cervical, thoracolumbar, prospective, and retrospective studies as well as the durations of follow-up for each study.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>In the 105 articles reviewed, there were 79,471 patients with 13,067 reported complications for an overall complication incidence of 16.4% per patient. Complications were more common in thoracolumbar (17.8%) than cervical procedures (8.9%; p &lt; 0.0001, OR 2.23). Prospective studies yielded a higher incidence of complications (19.9%) than retrospective studies (16.1%; p &lt; 0.0001, OR 1.3). The complication incidence for prospective thoracolumbar studies (20.4%) was greater than that for retrospective series (17.5%; p &lt; 0.0001). This difference between prospective and retrospective reviews was not found in the cervical studies. The year of study publication did not correlate with the complication incidence, although the duration of follow-up did correlate with the complication incidence (p = 0.001).</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Retrospective reviews significantly underestimate the overall incidence of complications in spine surgery. This analysis is the first to critically assess differing complication incidences reported in prospective and retrospective cervical and thoracolumbar spine surgery studies.</jats:p></jats:sec>

Complications in minimally invasive percutaneous fixation of thoracic and lumbar spine fractures and tumors

“…Furthermore, there is no statistically significant difference related to age for the complications rate [20].…”

Complications related to instrumentation in spine surgery: a prospective analysis

“…In a recent review of retrospective and prospective complications in spine surgery, the authors demonstrated a consistent underreporting of complications in retrospective studies. 18 Few studies offer an unambiguous examination of perioperative complications through prospective study. The majority of prospective assessments in the spine literature are industry-sponsored device trials that limit their assessment to specific spinal implants in carefully selected surgical patients.…”

Alterations in axial curvature of the cervical spine with a combination of rotation and extension in the conventional anterior cervical approach

“…Third, with regard to position, anesthetic management is easier. However, there are also several complications associated with the approach, including dysphagia, instrumentation backout, esophageal injury, cerebrospinal fluid leakage, wound infection, radiculopathy, C5 nerve palsy, and vertebral artery (VA) injury [2,[4][5][6][7][8][9][10][11][12].…”

“…However, due to the possibility of vertebrae rotation in subaxial vertebrae, care is required with regard to orientation. While cervical spinal movement has been widely studied [2,4,[6][7][8][9][10][11], the three-dimensional motion in coupling of extension and right rotation, which is relevant in the anterior approach position, is not well understood. There will be differences between the two cervical positions, i.e., the neutral supine position (N-position) and the conventional anterior approach position with extension and rotation (ER-position), which may lead to misdirection of drilling of the cervical vertebrae.…”