Komplikationen im zeitlichen Verlauf nach einer operativen Wirbelsäulenversorgung

Pepke, Wojciech; Wantia, C; Almansour, Haidara; Brückner, Thomas; Thielen, M

doi:10.1007/s00132-019-03770-1

Cited by 6 publications

(5 citation statements)

References 54 publications

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“…Another limitation of the NSQIP database is that NSQIP only records postoperative data up to 30 days after the procedure. Studies have shown that SSIs after ACDF can occur past the 30-day postoperative time point and that many infections can occur within the first 3 months after spine surgery 52,53 . Therefore, our study may not be capturing the extent to which postoperative complications, including SSIs, are occurring in both MetS and non-MetS patients after CDR.…”

Section: Discussionmentioning

confidence: 95%

“…Studies have shown that SSIs after ACDF can occur past the 30-day postoperative time point and that many infections can occur within the first 3 months after spine surgery. 52,53 Therefore, our study may not be capturing the extent to which postoperative complications, including SSIs, are occurring in both MetS and non-MetS patients after CDR. The NSQIP database is also limited in the availability of information regarding patients' socioeconomic status and level of education, 2 factors that may have associations with the risk of developing MetS.…”

Section: Discussionmentioning

confidence: 99%

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Impact of Metabolic Syndrome on Early Postoperative Outcomes After Cervical Disk Replacement

Zhao,

Shinn,

Basilious

et al. 2024

Clinical Spine Surgery

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Study Design: Retrospective cohort study. Objective: To compare the demographics, perioperative variables, and complication rates following cervical disk replacement (CDR) among patients with and without metabolic syndrome (MetS). Summary of Background Data: The prevalence of MetS—involving concurrent obesity, insulin resistance, hypertension, and hyperlipidemia—has increased in the United States over the last 2 decades. Little is known about the impact of MetS on early postoperative outcomes and complications following CDR. Methods: The 2005–2020 National Surgical Quality Improvement Program was queried for patients who underwent primary 1- or 2-level CDR. Patients with and without MetS were divided into 2 cohorts. MetS was defined, according to other National Surgical Quality Improvement Program studies, as concurrent diabetes mellitus, hypertension requiring medication, and body mass index ≥30 kg/m2. Rates of 30-day readmission, reoperation, complications, length of hospital stay, and discharge disposition were compared using χ2 and Fisher exact tests. One to 2 propensity-matching was performed, matching for demographics, comorbidities, and number of operative levels. Results: A total of 5395 patients were included for unmatched analysis. Two hundred thirty-six had MetS, and 5159 did not. The MetS cohort had greater rates of 30-day readmission (2.5% vs. 0.9%; P=0.023), morbidity (2.5% vs. 0.9%; P=0.032), nonhome discharges (3% vs. 0.6%; P=0.002), and longer hospital stays (1.35±4.04 vs. 1±1.48 days; P=0.029). After propensity-matching, 699 patients were included. All differences reported above lost significance (P>0.05) except for 30-day morbidity (superficial wound infections), which remained higher for the MetS cohort (2.5% vs. 0.4%, P=0.02). Conclusions: We identified MetS as an independent predictor of 30-day morbidity in the form of superficial wound infections following single-level CDR. Although MetS patients experienced greater rates of 30-day readmission, nonhome discharge, and longer lengths of stay, MetS did not independently predict these outcomes after controlling for baseline differences in patient characteristics. Level of Evidence: Level III.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Impact of Metabolic Syndrome on Early Postoperative Outcomes After Cervical Disk Replacement

Zhao,

Shinn,

Basilious

et al. 2024

Clinical Spine Surgery

View full text Add to dashboard Cite

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“…Moreover, we routinely perform CT imaging at the follow-up examinations, which allows a more precise assessment of screw positioning and potential dislocations than X-rays. Pepke et al [12] reported two peaks for postoperative complications. The first peak was observed within the first three months and the second peak in the second year after primary surgery.…”

Section: Discussionmentioning

confidence: 99%

“…[1,[8][9][10][11] The current data regarding revision surgery related to material failure have not been adequately investigated. A study group from the University Hospital of Heidelberg in Germany [12] has summarized the peak timing for complications and revision in spinal surgery. However, the study did not cover all relevant aspects.…”

Section: Introductionmentioning

confidence: 99%

Indications for early revision surgery for material failure in spinal instrumentation: experience at a level 1 center for spinal surgery – a single-center study

Banat¹,

Wach²,

Salemdawod³

et al. 2021

Medicine

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Posterior instrumentation is an established treatment for a range of spinal disorders. Material failure is not uncommon, and the indications for a revision are very heterogeneous. This study aimed to evaluate the indications and timing for early revision spinal surgery due to material failure. In this retrospective, single-center cohort study, patients underwent spinal posterior instrumentation between January 2017 and July 2019. They were followed up at 3, 12, and 18 months postoperatively. The time of onset of material failure which led to revision surgery was analyzed. In addition, the relationship between the indications for revision surgery and independent variables was examined using a multivariate logistic regression model. A total of one hundred thirty-five patients were enrolled. Radiolucent zones were found in 30 patients (20%) after 3 months, whereas 48 patients (31%) had radiolucent zones after 12 months. Revision surgery was performed in 13 patients (8.5%). The peak time for revision due to instability was within the first four months of the primary surgery. Multivariate analysis revealed that location, pathology, ASA score, and smoking had no significant impact on the indication for revision surgery, and neither did BMI ( P = .042). Non-fusion ( P = .007) and radiolucent zones ( P = .004), in combination with increased pain ( P = .006), were predictors for revision. Our data show that the peak time for early revision of material failure after posterior instrumentation was within the first 4 months of primary surgery. The abnormalities (e.g., radiolucent zones) surrounding the screws without fusion, including persistence of pain, were predictors for revision surgery.

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“…Since 7000 loading cycles are assumed to occur on an average patient's daily live according to the ASTM standard F1717 (2015) [27] and screw loosening has been observed to manifest between 3 and 6 months [28,29] as well as between 7 and 13 months after surgery [30], Liebsch et al recommended a testing duration of 1′800′000 cycles to cover this time period of interest [24]. The protocol used in this study utilized a testing duration of 1′800′000 loading cycles at a rate of 10 Hz resulting in a 50-h testing time per pedicle screw.…”

Section: Mechanical Test Set-upmentioning

confidence: 99%

Biomechanical performance of bicortical versus pericortical bone trajectory (CBT) pedicle screws

et al. 2021

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Purpose The cortical bone trajectory (CBT) is an alternative to the traditional pedicle screw trajectory (TT) in posterior spinal instrumentation, enhancing screw contact with cortical bone and therefore increasing fixation strength. Additional to the trajectory, insertion depth (pericortical vs. bicortical placement) could be a relevant factor affecting the fixation strength. However, the potential biomechanical benefit of a bicortical placement of CBT screws is unknown. Therefore, the aim of this study was to quantify the fixation strength of pericortical-versus bicortical-CBT (pCBT versus bCBT) screws in a randomized cadaveric study. Methods Pedicle screws were either placed pericortical or bicortical with a CBT in 20 lumbar vertebrae (2 × 20 instrumented pedicles) from four human spine cadavers by using patient-specific templates. Instrumented specimens underwent physiological cyclic loading testing (1′800′000 cycles, 10 Hz), including shear and tension loads as well as bending moments. Translational and angular displacements of the screws were quantified and compared between the two techniques. Results There was a slight decrease in translational (0.2 mm ± 0.09 vs. 0.24 mm ± 0.11) and angular displacements (0.06° ± 0.05 vs. 0.13° ± 0.11) of bCBT screws when compared with pCBT screws after 1′800′000 cycles. However, the results were non-significant (p > 0.05). Conclusion The authors do not recommend placing CBT screws bicortically, as no relevant biomechanical advantage is gained while the potential risk for iatrogenic injury to structures anterior to the spine is increased.

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Komplikationen im zeitlichen Verlauf nach einer operativen Wirbelsäulenversorgung

Cited by 6 publications

References 54 publications

Impact of Metabolic Syndrome on Early Postoperative Outcomes After Cervical Disk Replacement

Impact of Metabolic Syndrome on Early Postoperative Outcomes After Cervical Disk Replacement

Indications for early revision surgery for material failure in spinal instrumentation: experience at a level 1 center for spinal surgery – a single-center study

Biomechanical performance of bicortical versus pericortical bone trajectory (CBT) pedicle screws

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