Pulmonary Complications following Thoracic Spinal Surgery: A Systematic Review

Gabel, Brandon C; Schnell, Eric C.; Dettori, Joseph R; Jeyamohan, Shiveindra; Oskouian, Rod J.

doi:10.1055/s-0036-1582232

Cited by 15 publications

(7 citation statements)

References 15 publications

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“…27 Nevertheless, the retropleural approaches require intimate navigation of the critical respiratory structures, and patients are at risk of experiencing pneumothorax, diaphragm injury, rib pain, and pleural effusion. 31 In our series, 3 of the TLJ patients had pneumothorax, in contrast to 0% in the lumbar and thoracic spine (Table 3).…”

Section: Discussionmentioning

confidence: 50%

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Extreme Lateral Interbody Fusion for Thoracic and Thoracolumbar Disease: The Diaphragm Dilemma

Glinski

Elia

Takayanagi

et al. 2020

Global Spine Journal

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Study Design: Retrospective cohort study. Objective: Complication profiles for lateral approaches to the spine are well established. However, the influence of level of surgery on complication rates and subtypes are less well established. To determine risk factors for complications as determined by level and surgery type in patients undergoing a lateral (retroperitoneal or retropleural approach) to the thoracolumbar spine. Methods: All adult patients undergoing a lateral thoracolumbar fusion with or without posterior instrumentation performed at a single institution were identified. Primary outcomes assessed were presence of complication, complication subtype, and need for reoperation. The primary independent variables were spinal level (thoracic, thoracolumbar, or lumbar) and type of surgery (discectomy or corpectomy). Categorical outcomes were compared using chi-square test. Unadjusted and adjusted odds ratios for corpectomy status were calculated to determine risk of complication by level. P < .05 was considered statistically significant. Results: A total of 165 patients aged 18 to 75 years were identified as having undergone a lateral fusion. Complication rates were 28.6%, 36.4%, and 11% for thoracic, thoracolumbar, and lumbar lateral approach fusions, respectively. Under univariate analysis, patients undergoing lateral approach in the thoracic spine group had significantly higher rates of postoperative complications than those in the lumbar group ( P = .005). After adjusting for corpectomy status, there was no difference in complication rates. Conclusions: Lateral (retroperitoneal or retropleural) approaches to the thoracic and thoracolumbar spine may be used with complication rates comparable to well-established lumbar approaches. Extent of surgery (corpectomy vs discectomy) rather than level of surgery may represent the primary driver of complications.

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Section: Discussionmentioning

confidence: 50%

Section: Discussionmentioning

confidence: 99%

Extreme Lateral Interbody Fusion for Thoracic and Thoracolumbar Disease: The Diaphragm Dilemma

Glinski

Elia

Takayanagi

et al. 2020

Global Spine Journal

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“…These complications have been previously reported in the literature related to the LLIF approach. 22 Our rate of pleural complications (5.1%) is at the low end of published data, which ranges from 2.5% 23 to 44%. 24 In our study no patient required chest tube placement.…”

Section: Discussionmentioning

confidence: 70%

The feasibility of computer-assisted 3D navigation in multiple-level lateral lumbar interbody fusion in combination with posterior instrumentation for adult spinal deformity

Strong¹,

Yee²,

Khalsa³

et al. 2020

Neurosurgical Focus

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OBJECTIVEThe lateral lumbar interbody fusion (LLIF) technique is used to treat many common spinal degenerative pathologies including kyphoscoliosis. The use of spinal navigation for LLIF has not been broadly adopted, especially in adult spinal deformity. The purpose of this study was to evaluate the feasibility as well as the intraoperative and navigation-related complications of computer-assisted 3D navigation (CaN) during multiple-level LLIF for spinal deformity.METHODSRetrospective analysis of clinical and operative characteristics was performed for all patients > 18 years of age who underwent multiple-level CaN LLIF combined with posterior instrumentation for adult spinal deformity at the University of Michigan between 2014 and 2020. Intraoperative CaN-related complications, LLIF approach–related postoperative complications, and medical postoperative complications were assessed.RESULTSFifty-nine patients were identified. The mean age was 66.3 years (range 42–83 years) and body mass index was 27.6 kg/m2 (range 18–43 kg/m2). The average coronal Cobb angle was 26.8° (range 3.6°–67.0°) and sagittal vertical axis was 6.3 cm (range −2.3 to 14.7 cm). The average number of LLIF and posterior instrumentation levels were 2.97 cages (range 2–5 cages) and 5.78 levels (range 3–14 levels), respectively. A total of 6 intraoperative complications related to the LLIF stage occurred in 5 patients. Three of these were CaN-related and occurred in 2 patients (3.4%), including 1 misplaced lateral interbody cage (0.6% of 175 total lateral cages placed) requiring intraoperative revision. No patient required a return to the operating room for a misplaced interbody cage. A total of 12 intraoperative complications related to the posterior stage occurred in 11 patients, with 5 being CaN-related and occurring in 4 patients (6.8%). Univariate and multivariate analyses revealed no statistically significant risk factors for intraoperative and CaN-related complications. Transient hip weakness and numbness were found to be in 20.3% and 22.0% of patients, respectively. At the 1-month follow-up, weakness was observed in 3.4% and numbness in 11.9% of patients.CONCLUSIONSUse of CaN in multiple-level LLIF in the treatment of adult spinal deformity appears to be a safe and effective technique. The incidence of approach-related complications with CaN was 3.4% and cage placement accuracy was high.

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“…Traditional procedures often expose patients to a higher risk of direct mechanical trauma, lung contusion, and other pulmonary complications that are often attributed to the inadvertent violation of the elements within the thoracic cavity while accessing the spine [24]. This is supported by a 2016 systematic review that evaluated pulmonary complication incidence in thoracic spinal surgery.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Clinical Outcomes of Minimally Invasive Direct Thoracic Interbody Fusion: A Retrospective Analysis

Abbasi¹,

Storlie²,

Gonzalez³

et al. 2023

Cureus

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Introduction: A unique surgical approach -the minimally invasive direct interbody fusion (MIS-DTIF) -was previously introduced in our proof-of-concept study, which included four patients who underwent thoracic interbody fusion below the scapula at the T6/7 vertebral level. However, due to the novelty of this method, a report of associated operative parameters such as pain, function, and clinical outcomes from an expanded patient cohort was needed to assess the validity of our results.Materials and Methods: Following IRB approval, data were analyzed retrospectively from electronic health records between 2014 and 2021. Inclusion criteria were patients ≥18 years old who underwent minimally invasive thoracic interbody fusion using the MIS-DTIF technique for at least one vertebral level. The primary outcomes included demographic/radiographic features (e.g., age). Secondary outcomes included perioperative clinical features (e.g., preoperative and ≥1-year final follow-up (FFU)). Tertiary outcomes included perioperative complications. Both preoperative and FFU patient-reported pain and functional outcomes (ODI scores) were analyzed using t-tests to establish significance.Results: A total of 13 patients who underwent MIS-DTIF surgery were observed, with eight male patients and five female patients. The average age was 49.2 years, with an average BMI of 30.5 kg/m 2 . Of the surgeries included, the majority (69.23%) were 1-level thoracic vertebrae fusions -with 2-level fusions and ≥ 3-level fusions accounting for 15.38% and 15.38% of cases, respectively. The mean operative time was 58.9 ± 19.9 minutes, with an average fluoroscopy time of 285.7 ± 126.8 seconds and an average actual blood loss volume of 109.0 ± 79.0 mL. The average hospital length of stay was 1.1 (±1.7) days, and no clinically significant perioperative complications were observed in this patient cohort. The average follow-up period was 12.1 ± 9.6 months, with preoperative and FFU back pain visual analog scale (VAS) scores showing highly significant improvement (p<0.001). In addition to pain reduction, quality of life improvements was noted, with significant differences in some of the ODI domains between preoperative and FFU scores (p<0.05), as well as the overall total score between preoperative and FFU ODI assessment (p<0.001) -both of which reflect increased patient function and decreased disability. Conclusion:This study provides further evidence for the safety and efficacy of the MIS-DTIF approach for surgical management of symptomatically refractory patients with thoracic disc herniation or stenosis owing to degenerative disc disease or compression fractures. Additionally, the data gathered suggests that this minimally invasive procedure offers many clinical benefits, including less tissue damage, decreased intraoperative blood loss, shortened surgery time, and shortened hospital length of stay. Finally, in addition to significant pain intensity improvement, this study showed that treated patients highly benefited from 'sleeping' and 'return-to-work' dom...

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Pulmonary Complications following Thoracic Spinal Surgery: A Systematic Review

Cited by 15 publications

References 15 publications

Extreme Lateral Interbody Fusion for Thoracic and Thoracolumbar Disease: The Diaphragm Dilemma

Extreme Lateral Interbody Fusion for Thoracic and Thoracolumbar Disease: The Diaphragm Dilemma

The feasibility of computer-assisted 3D navigation in multiple-level lateral lumbar interbody fusion in combination with posterior instrumentation for adult spinal deformity

Efficacy and Clinical Outcomes of Minimally Invasive Direct Thoracic Interbody Fusion: A Retrospective Analysis

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