Search

Background: Surgical intervention is performed on the cervical spine in a heterogeneous number of pathologic conditions in a diverse patient population. Several authors have examined complication prevalence in cervical spine surgery using retrospective analysis. However, few prospective studies have directly examined perioperative complications. Most prospective studies in the spine literature have assessed only specific spinal implants in carefully selected surgical patients, and complication incidence in broader patient populations is limited. Objectives: To prospectively collect data on all patients who underwent cervical spine surgery at a large tertiary care center and to evaluate the effect of the approach and the incidence of early complications. Methods: Data were collected prospectively on 119 patients admitted to the neurosurgical service at Thomas Jefferson University hospital from May to December 2008. Data collected consisted of preoperative diagnosis, medical comorbidities, body mass index, surgical approach, length of stay, and complications, and were analyzed using multivariate regression analysis. Complications occurring within 30 days after each operative procedure were included. Medical adverse events, regardless of their relationship to the operative intervention, were also included as complications. A previously validated binary definition of major and minor complications was used to stratify the data. Results: Overall, 53 of 119 patients (44.5%) experienced at least one complication. Eleven of 41 patients (26.8%) undergoing only an anterior cervical procedure had a perioperative complication, compared with 26 of 53 patients (49.0%) undergoing only a posterior cervical procedure (P = .01). In patients undergoing a combined anterior and posterior surgical procedure, 16 of 25 (66%) experienced a complication, a significant difference in comparison with solitary anterior procedures (P = .004). Anterior procedures were associated with postoperative dysphagia and vocal cord paresis, whereas wound infection and C5 palsy was more frequently recorded in the group undergoing surgery via an isolated posterior approach. Conclusions: The incidence of complications or adverse events is not definitely known for most spinal procedures because of the complexity of defining complications and obtaining accurate data. Therefore, to obtain a more accurate assessment of spinal procedures, a prospective algorithm was designed to collect and record complications during the acute perioperative period. Using this technique, a significantly higher complication rate was documented than had been previously reported for cervical spine operative interventions. In addition, use of a broad definition of perioperative complications likely increased the recorded incidence of perioperative adverse events and complications. Complications were more common in patients undergoing posterior and anteroposterior procedures. [Copyright &y& Elsevier]

Background: Thoracic and lumbar spine surgical procedures are performed for a variety of pathologies. The literature consists of multiple retrospective reviews examining complication prevalence with the surgical treatment of these disorders. However, there is limited direct examination of perioperative complications through a prospective approach. Of the prospective assessments, the majority focuses on specific surgical procedures or provides a limited assessment of certain spinal implants. Prospective assessments of complication incidence in broad patient populations are limited. This article analyzes a prospectively collected database of patients who underwent a thoracic and/or lumbar spine surgery at a large tertiary care center and the effect of surgical approach (anterior or posterior) on the incidence of early complications. Methods: Data collection was performed prospectively on 128 patients on the neurosurgical spine service at Thomas Jefferson University hospital from May to December 2008. Data on preoperative diagnosis, medical comorbidities, body mass index, surgical approach and procedure, length of stay, and complication occurrence was recorded and analyzed. Acute complications or adverse events occurring within the initial 30 days after each operative procedure were included. All medical adverse events were included as complications. A previously circumstantiated binary definition of major and minor complications was used to stratify the data. Results: Overall, 76 of 128 patients (59.4%) in this cohort experienced at least one complication. Anterior thoracic and lumbar procedures had an 83.3% (5/6) incidence of complications. Of those patients having solely a posterior thoracic and lumbar procedures, 37 of 75 (49.3%) experienced at least one complication. Combined anterior and posterior surgical procedure had a complication incidence of 34 of 47 (72.3%). The mean number of complications reached significance for the minor and overall complications groups (P = .0076 and .0172, respectively, Poisson regression). Comparing the incidence of complications reveals the overall complications in the posterior alone group compared with the anterior/posterior combined group was significantly lower (P = .0134). Those undergoing instrumented fusions were statistically more likely to encounter complications (P<.001). Conclusions: There is a considerably higher complication incidence than previously reported for thoracic, thoracolumbar, and lumbar spine operations. A prospective approach and a broad definition of perioperative complications increased the recorded incidence of perioperative adverse events and complications. The case complexity of a tertiary referral center may also have escalated the increased incidence. Complications were more common in patients undergoing anterior and anterior/posterior procedures. [Copyright &y& Elsevier]