Complication Of Lumbar Spine Surgery Research Articles

Enhanced technique of dural closure using autologous fat graft and Gelfoam for effective management of dural tear following interlaminar endoscopic lumbar spine surgery.

Incidental dural tears are common complications in lumbar spine surgery, particularly in endoscopic procedures where primary closure via suturing is challenging. The absence of a standardized approach for dural closure in endoscopic spine surgery necessitates exploring alternative techniques. This study introduces a surgical technique for dural closure utilizing fat graft and Gelfoam, offering an effective alternative to standard approaches in endoscopic spine surgery. Surgical data from patients who underwent interlaminar endoscopic discectomy or stenosis decompression at Lerdsin Hospital from October 2014 to October 2021 were analyzed. Among 393 cases, dural tears occurred in 2% (8 patients). Our technique achieved successful closure in all these cases, with no incidents of cerebrospinal fluid leakage or wound complications. The majority of patients showed favorable clinical outcomes, except for one case involving concomitant nerve root injury. This study demonstrates that using fat graft and Gelfoam for dural closure is a simple, reliable, and safe technique, particularly effective for challenging-to-repair areas in interlaminar endoscopic lumbar spine surgery.

Unintended dural tears during unilateral biportal endoscopic lumbar surgery: incidence and risk factors

BackgroundAn unintended dural tear (DT) is the most common intraoperative complication of lumbar spine surgery. The unilateral biportal endoscopic technique (UBE) has become increasingly popular for treating various degenerative diseases of the lumbar spine; however, the DT incidence and risk factors specific to UBE remain undetermined. Therefore, this study aimed to evaluate the incidence and risk factors of DTs in UBE.MethodData from all patients who underwent UBE for degenerative lumbar spinal diseases from November 2018 to December 2021 at our institution were used to assess the effects of demographics, diagnosis, and type of surgery on unintended DT risk.ResultsOverall, 24/608 patients (3.95%) experienced DTs and were treated with primary suture repair or bed rest. Although several patients experienced mild symptoms of cerebrospinal fluid (CSF) leaks, no serious postoperative sequelae such as nerve root entrapment, meningitis, or intracranial hemorrhage occurred. Additionally, no significant correlations were identified between DT and sex (P = 0.882), body mass index (BMI) (P = 0.758), smoking status (P = 0.506), diabetes (P = 0.672), hypertension (P = 0.187), or surgeon experience (P = 0.442). However, older patients were more likely to experience DT than younger patients (P = 0.034), and patients with lumbar spinal stenosis (LSS) were more likely to experience DT than patients with lumbar disc herniation (LDH) (P = 0.035). Additionally, DT was more common in revision versus primary surgery (P < 0.0001) and in unilateral laminotomy with bilateral decompression (ULBD) versus unilateral decompression (P = 0.031). Univariate logistic regression analysis revealed that age, LSS, ULBD, and revision surgery were significant risk factors for DT.ConclusionsIn this UBE cohort, we found that the incidence of DT was 3.95%. Additionally, older age, LSS, ULBD, and revision surgery significantly increased the risk of DT in UBE surgery.

Efficacy of patch technique for dural tear repair using hydrogel sealant: a pilot study

BACKGROUND CONTEXTDural tear is one of the common complications of lumbar spine surgery. Suture repair is often difficult due to the requirement of meticulous suture technique in limited space. Dural tear repair is particularly challenging in minimally invasive spine surgery. The patch technique, applying patch material and glue without suture, is an alternative method for dural tear repair. PURPOSETo verify the efficacy of patch technique for dural tear repair using polyethylene glycol hydrogel sealant and to compare patch materials. STUDY DESIGN/SETTINGBasic research. METHODSThere were three study groups: Group 1 (control group, n=4) had hydrogel sealant alone, Group 2 (n=8) had collagen sheet patch and hydrogel sealant, Group 3 (n=8) had mesh sheet patch and hydrogel sealant. A 4-mm durotomy was made in a piece of bovine dura using an arterial punch. Patch material (collagen or mesh sheet) was placed over the dural tear with 2 mm margin and then sprayed with hydrogel sealant. The pressure in the system was increased by 10 mm Hg and monitored. When the leakage occurred, the pressure threshold was measured. RESULTSThe mean pressure threshold for leakage was 32.5 (Standard deviation=15.0), 66.3 (37.0), and 88.8 (27.5) mm Hg for Group 1, 2 and 3, respectively. The mean pressure threshold for leakage for Group 3 was significantly higher than that for Group 1 (p<.05). There was no significant difference in the mean pressure threshold for leakage between Groups 1 and 2, and Groups 2 and 3. CONCLUSIONSPatch technique using mesh sheet and hydrogel sealant demonstrated significantly higher mean pressure threshold for leakage compared with hydrogel sealant alone. CLINICAL SIGNIFICANCEPatch technique using mesh sheet and hydrogel sealant without suture is potentially a reasonable option for dural tear repair in lumbar spine surgery.

ԿՐԾՔԱԳՈՏԿԱՅԻՆ ՄԻՋՓԱԿԵՂԱՅԻՆ ՀԱՐԹՈՒԹՅԱՆ ՊԱՇԱՐՄԱՆ (THORACOLUMBAR INTERFASCIAL PLANE BLOCK - TLIP) ԿԻՐԱՌՈՒՄԸ ՈՂՆԱՇԱՐԻ ԳՈՏԿԱՅԻՆ ՀԱՏՎԱԾՈՒՄ ԿԱՏԱՐՎՈՂ ՎԻՐԱՀԱՏՈՒԹՅՈՒՆՆԵՐԻ ԺԱՄԱՆԱԿ․ ԳՐԱԿԱՆՈՒԹՅԱՆ ՏԵՍՈՒԹՅՈՒՆ

Pain management after spine surgery is challenging and usually not sufficient. Most patients suffer from severe postoperative pain. Numerous studies have demonstrated the effectiveness of various regional anesthetic techniques in postoperative pain management. In recent years, thoracolumbar interfascial plane block (TLIP) has become widely used for perioperative analgesia during lumbar spine surgeries. It is a type of ultrasound-guided plane block, during which a local anesthetic is injected into the fascial plane between the multifidus and longissimus muscles, with the aim of blocking the dorsal rami of the thoracolumbar nerves. TLIP block was first proposed by Hand et al. in 2015. The aim of this study is to review the scientific publications regarding the use of TLIP block in lumbar spine surgery in the most popular electronic databases, such as PubMed, Scopus, Google Scholar, Web of Science, and comparing lumbar spine surgeries with and without TLIP block according to the following criteria: postoperative pain intensity, postoperative analgesic requirement, intraoperative opioid use, incidence of postoperative nausea and vomiting, comparison with other regional anesthesia methods. Analysis of the reviewed literature shows that TLIP block in lumbar spine surgery reduces the requirement of perioperative analgesics, decreases the intensity of postoperative pain up to 24 hours postoperatively, reduces the frequency of postoperative nausea and vomiting, therefore, is an effective method and can be used in daily practice. At the same time, almost all researchers consider that obtained data quality is low and that more studies with a larger number of patients and a longer duration are needed to statistically confirm the obtained data. In particular, studies are needed to determine whether TLIP block is sufficiently effective compared to other regional anesthesia methods, especially erector spinae plane block (ESP), whether TLIP block reduces the incidence of chronic pain syndrome, whether it affects the duration of surgery, postoperative intensive care unit treatment and length of hospital stay, whether TLIP-block reduces intraoperative blood loss, whether it is possible to prolong and enhance the effect of TLIP block with adjuvants, in particular dexamethasone and dexmedetomidine. Thoracolumbar interfascial plane block (TLIP) is a promising method for perioperative analgesia, reduction of analgesic use and postoperative complications in lumbar spine surgery, however, further studies are needed to determine its effectiveness and optimal application methods.

221. Efficacy of patch technique for dural tear repair

221. Efficacy of patch technique for dural tear repair

The Usefulness of Trabecular CT Attenuation Measurement at L4 Level to Predict Screw Loosening After Degenerative Lumbar Fusion Surgery: Consider Number of Fused Levels and Postoperative Sagittal Balance.

Retrospective study. To evaluate the absolute value of L4 trabecular region-of-interest (t-ROI) computed tomography (CT) attenuation, which can predict pedicle screw loosening, and determine the changes in value according to number of fused levels and sagittal balance in patients undergoing lumbar fusion surgery. Although osteoporosis was not diagnosed in spinal dual x-ray absorptiometry preoperatively, we encountered several cases of screw loosening within 1 year of lumbar fusion surgery. We enrolled 478 patients and analyzed factors related to screw loosening. We evaluated the association between L4 t-ROI CT attenuation and screw loosening and determined the best cutoff value of t L4 t-ROI CT attenuation for predicting screw loosening. The number of fused levels, postoperative C7-S1 sagittal vertical axis (SVA), and L4 t-ROI CT attenuation were independently correlated with screw loosening. According to number of fused level and postoperative C7-T1 SVA (≥36.9 mm or <36.9 mm), in patients with one-level fusion and C7-S1 SVA less than 36.9 mm, the optimal cutoff point of the L4 t-ROI CT attenuation predicting screw loosening was 106.5 Hounsfield unit (HU). L4 t-ROI attenuation did not change until two-level fusions. In patients with three-level fusions and C7-S1 SVA less than 36.9 mm, the optimal cutoff point of the L4 t-ROI CT attenuation predicting screw loosening was 159.0 HU. The optimal cutoff point of L4 t-ROI CT attenuation in patients with three-level fusions and C7-S1 SVA more than or equal to 36.9 mm was 191.0 HU. L4 t-ROI CT attenuation value considering number of fused levels and sagittal balance is an accurate measurement method to predict screw loosening. Spine surgeons should be aware of the L4 t-ROI attenuation before surgery to improve the fusion rate and reduce instrument-related complications of lumbar spine surgery in osteoporotic patients. 3.

Protein Supplement and Enhanced Recovery After Posterior Spine Fusion Surgery: A Randomized, Double-blind, Placebo-controlled Trial.

This was a randomized, double-blind clinical trial study. The objective of this study was to evaluate the effect of protein supplementation on vertebral fusion and enhanced recovery after posterior spine fusion (PSF) surgery. Nonfusion is one of the most common complications of lumbar spine surgery. It has been shown that protein plays an important role in bone repair; however, its correlation to vertebral fusion following PSF surgery is unknown. In this randomized, double-blind clinical trial study, the intervention group received a diet with 1.2 g of protein plus high-protein supplement (36 g whey protein), and the control group received a similar diet, except for starch as a placebo from 48 hours before to 1 month after surgery. The intervention group showed a significantly higher rate of vertebral fusion compared with the control group (P=0.019). Surgical site infection and pain were significantly lower in the intervention group. A significant difference was found in the wound healing rate in favor of the intervention group. The rates of decrease in serum high-sensitivity C-reactive protein levels and increase in serum levels of insulin-like growth factor 1, albumin, total protein, and alkaline phosphatase were greater in the intervention group than in the control group (P<0.001). Increased protein intake improves vertebral fusion and enhances recovery in patients undergoing PSF. This was the first study to investigate the effect of protein on fusion and healing factors; as a result, further clinical trials are needed to confirm the current results.

Multilayer Mattress Stitches for Complicated Wounds in Spine Surgery.

Introduction Local infection and prolonged fluid discharge account for most complications in lumbar spine surgery. This report is a brief description of a useful technique for revision of complicated, draining wounds with surprisingly positive results that otherwise frequently require multiple surgical interventions. Technical Note We describe the postoperative course of three patients, with prolonged and continuous serosanguineous discharge from the skin incision, who underwent wound revision with multilayered mattress stitches after open decompressive or instrumented spinal surgery. For this purpose, a thick monofilament suture is passed through the skin, subcutaneous fatty tissue, and paravertebral muscle in the fashion of a vertical mattress stitch while the loop above the skin level is augmented using a soft silicone capillary drainage to distribute tension along the wound margin. Conclusions None of the patients treated with the multilayered mattress stitches required further surgical intervention. In this small case series, the multilayered mattress stitches augmented with soft silicone tubing were a useful technique for treating complicated lumbar surgical wounds with prolonged serosanguineous discharge.

Вплив методу анестезії на розвиток післяопераційних ускладнень в хірургії поперекового відділу хребта

Вплив методу анестезії на розвиток післяопераційних ускладнень в хірургії поперекового відділу хребта

Symptomatic Epidural Hematoma after Elective Posterior Lumbar Decompression: Incidence, Timing, Risk Factors, and Associated Complications.

Symptomatic post-operative lumbar epidural hematoma (PLEH) is a complication of lumbar spine surgery that can cause permanent neurologic consequences through compression of the cauda equina and nerve roots. We sought to investigate the incidence, timing, and risk factors for symptomatic epidural hematomas following posterior lumbar decompression, as well as to identify additional post-operative complications associated with symptomatic lumbar epidural hematomas. Elective lumbar spine procedures were identified in the National Surgical Quality Improvement Program (NSQIP) database between 2012 and 2016. Analyzed predictors of reoperation or readmission within 30days for symptomatic PLEH included demographics, comorbidities, pre-operative laboratory values, peri-operative characteristics, and post-operative complications. There were 75,878 cases included in the analysis. The incidence rate of symptomatic PLEH was 0.27% (n = 206), 54.4% (n= 112) of which occurred within 5days of the procedure. Increased age, obesity (body mass index of 35 or higher), peri-operative transfusion, multilevel surgery (two or more levels), dural tear repair, and microscope use were independently associated with PLEH. Post-operative complications associated with PLEH included surgical site infection and urinary tract infection. Readmission or reoperation for symptomatic PLEH following elective lumbar spine surgery is rare and can occur many days or weeks after a procedure. There are modifiable risk factors for PLEH and associated additional post-operative complications that physicians should be suspicious of following posterior lumbar decompression.

Depression Increases the Rates of Neurological Complications and Failed Back Surgery Syndrome in Patients Undergoing Lumbar Spine Surgery.

This was a retrospective database study. The aim of this study was to use a large sample to accurately determine risk factors and rates of neurological complications in patients undergoing commonly performed lumbar spine surgeries. Damage to neurological structures and failed back surgery syndrome (FBSS) are among the most feared complications of lumbar spine surgery. Despite the large impact on quality of life these complications have, reported rates of neurological complications vary immensely, ranging from 0.46% to 24%. Data were obtained for patients undergoing initial posterior lumbar interbody fusion, transforaminal lumbar interbody fusion, anterior lumbar interbody fusion, posterolateral fusion, discectomy, and laminectomy procedures from January 2007 to June 2015 covered by the nationwide insurance carrier Humana. Patient records were analyzed to determine rates of dural tear, damage to nervous tissue, cauda equina syndrome, neurogenic bowel/bladder, and FBSS following each procedure. Rates were determined for patients undergoing single/multilevel procedures, by age, and for patients with a previous diagnosis of depression to determine the influence these factors had on the risk of neurologic complications. Analysis of 70,581 patient records revealed a dural tear rate of 2.87%, damage to the nervous tissue of 1.47%, cauda equina syndrome of 0.75%, neurogenic bowel or bladder of 0.45%, and FBSS of 15.05% following lumbar spine surgery. The incidence of complications was highest for patients undergoing multilevel procedures and posterior fusion. Depression was a significant risk factor for FBSS (risk ratio, 1.74; P<0.0001), damage to nervous tissue (1.41; P<0.0001), and dural tear (1.15; P<0.0001), but had no impact on risk of cauda equina syndrome or neurogenic bowel or bladder. Increased age was associated with higher rates of dural tear and damage to nervous tissue. Patients with a history of depression are at significantly increased risk for neurologic complications following lumbar spine surgery and should be managed accordingly.

Bariatric Surgery and Low Back Pain: A Systematic Literature Review.

Study Design:Systematic literature review.Objective:It is estimated that one third of the world population is overweight and 20% of adults have some low back symptoms at some point of their lives. The association of obesity and low back pain and physical deterioration has been well established. We designed this study to evaluate the role of bariatric surgery (BS) for lumbar spine symptoms in obese patients.Methods:A systematic literature review was performed using the PubMed database identifying lumbar spine symptoms (pain, functional status, disability index) and/or complications of lumbar spine surgery before and after BS. Study quality was assessed according to the Oxford Centre for Evidence-Based Medicine.Results:Ten studies were identified. Nine evaluated the role of BS in low back pain and/or functional status before and after surgery: all reported that bariatric surgery had a positive impact in improving low back pain symptoms and decreasing disability in severely obese patients. One study evaluated the role of posterior lumbar surgery in patients who were obese at the time of surgery and those who had a previous bariatric procedure: bariatric surgery decreased postoperative surgical complications. The level of the evidence was low (III and IV).Conclusions:Bariatric surgery in severely obese patients decreases the intensity of low back symptoms and also decreases disability secondary to back problems. Additionally, bariatric surgery may be advantageous for patients who need a posterior lumbar surgery and are severely obese. Prospective studies with longer follow-up are necessary to confirm this conclusion.

Early mobilisation does not increase the complication rate from unintended lumbar durotomy

Background: Unintended durotomy is a well-recognised complication of lumbar spine surgery. Reported complications include headaches, intracranial haematomata, pseudomeningocoele and infection. Methods of intraoperative repair vary and although post-operative flat bed rest is advocated by some, there is no consensus on duration. We reviewed a series of unintended durotomies that occurred in our institution and reviewed them to compare management strategies and outcome.Methods: A retrospective analysis was conducted of adult patients who experienced an unintended durotomy during surgery for lumbar degenerative disease in our neurosurgical unit over a 15-month period. Post-operative complications were followed up for a minimum of 3 months.Results: 1125 patients underwent elective or emergency decompressive lumbar spine surgery. 45 (4%) dural tears were identified; all were repaired intra-operatively with suturing, Tisseal thrombin glue or both. Absence of leakage was confirmed on Valsalva manoeuvre for all cases, before wound closure. 28 patients were mobilised within 24 hrs of surgery, 16 patients between 24–48 hours and 1 patient after 48 hours. Seven patients (16%) with a dural tear experienced a complication. There was no statistically significant relationship between time to post-operative mobilisation and complication rate (p = .76). There was a significantly longer inpatient stay when patients were on bed rest for longer (2 tailed test significant at the 2% level).Conclusion: Duration of post-operative bed rest was not related to complication rate but led to delays in discharge. We did not find evidence that early mobilisation lead to increased likelihood of complications.

Use of the subcutaneous lumbar spine (SLS) index as a predictor for surgical complications in lumbar spine surgery

Background contextLumbar spine surgeries require adequate exposure to visualize key structures and limited exposure can make surgery more technically difficult, thus increasing the potential for complications. Body mass index and body mass distribution have been shown to be associated with worse surgical outcomes. PurposeThis study aims to further previous investigations in elucidating the predictive nature of body mass distribution with peri- and postoperative complications in lumbar surgery. Study Design/SettingThis is a retrospective study conducted at a single institution. Patient SampleTwo hundred eighty-five patients who underwent lumbar laminectomy, laminotomy, or posterior lumbar interbody fusion or transforaminal lumbar interbody fusion procedures between 2013 and 2016. Outcome MeasuresMagnetic resonance imaging (MRI) results and electronic medical records were reviewed for measurements and relevant complications. MethodsPreviously known risk factors were identified and MRI measurements of subcutaneous adipose depth (SAD) relative to spinous process height (SPH) were measured at the surgical site to generate the subcutaneous lumbar spine (SLS) index. This measurement was then analyzed in association with recorded surgical complications. ResultsThe SLS index was found to be a significant risk factor for total complications (0.292, p=.041), perioperative complications (0.202, p=.015), and need for revision surgery (0.285, p<.001). The SAD alone proved to be negatively associated with perioperative complications (−0.075, p=.034) and need for revision surgery (−0.104, p=.001), with no predictive association seen for total or postoperative complications. Linear regression revealed an SLS index of 3.43 as a threshold value associated with a higher risk of total complications, 5.8 for perioperative complications, and 3.81 for the need for revision surgeries. ConclusionBody mass distribution of the surgical site as indicated by SAD to SPH (SLS index) is significantly associated with increasing risk of postoperative and perioperative complications as well as increased likelihood for necessary revision surgery. This relationship was shown to be a more accurate indication of perioperative risk than previous standards of body mass index and SAD alone, and may allow spine surgeons to assess surgical risk when considering lumbar spine surgery using simple calculations from standard preoperative MRI results.

Peri-operative complications of lumbar spine surgery in patients over eighty five years of age: a retrospective cohort study.

To compare peri-operative complication rates in ≥ 85-year-old patients who underwent decompression surgery with or without instrumented fusion for degenerative disorders. This study involved 907 patients who underwent lumbar spine surgery for degenerative disorders between January 2006 and June 2012. Of these, 33 patients (3.6% of the entire population) were over 85years of age (85-94years). Decompression-alone and instrumentation groups were compared in terms of comorbidities, American Society of Anesthesiologists (ASA)-physical status (PS) class, peri-operative complications, and Japanese Orthopedic Association (JOA) scores. Thirty-three ≥ 85-year-old patients underwent surgery. All were ASA-PS class 2 (94%) or 3. The decompression-alone (n = 19) and instrumentation (n = 14) groups did not differ in comorbidity (95 vs. 100%, P = 0.383) or ASA-PS class (P = 0.561). Both exhibited improved JOA scores (decompression-alone: 13.4/29 to 22.7/29; instrumentation: 8.6/29 to 17.9/29; P = 0.9068) and had similar peri-operative complication rates (21.0 vs. 28.5%, P = 0.374). Although instrumentation is considered more invasive than decompression, we detected no statistically significant differences in peri-operative complication rates between these two types of surgery in ≥ 85-year-old patients. Surgeons should perform instrumentation even in the patients over 85years with ASA class 3 or less.

Predisposing Factors for Dural Tear during Lumbar Spine Surgery

AbstractBackground: Dural tear is a common complication of lumbar spine surgery. The aim of this prospective study was to identify the predisposing factors for dural tear in lumbar spine surgery.Patients and Methods: We prospectively recorded data of 174 patients with lumbar spine surgery from 2013 to 2016 in Faculty of Medicine, Bani seuf University. We compared result obtain from the patients in which a dural tear occurred (Group A) and those in which a dural tear did not occur (Group B) excluded criteria are recurrent procedures, and intradural procedures.All the patient data like age, sex clinical examination, and scheduled procedure, and intra-operative data (surgeon experience. Type and time of surgery) were record and com-pared between the two groups.Results: 104 patients underwent discectomy, 50 patients underwent laminectomy. And 20 patients underwent lumber fixation. Among the 104 patients who underwent discectomy 5 patients had a dural tear. Among the 50 patients who under-went laminectomy 3 patients had dural tear. Amongthe 20 patient underwent lumber fixation 2 patients had dural tear. Patients with incidental durotomy were older (mean 60±5 vs 50±5 years), and had longer surgery (180±30 vs 120±30 minutes), compared with the patients without dural tear. The incidence was significantly higher with lumber fixation (pro-longed surgery) when physician training was examined; residents were responsible for 50% of all dural tear.Conclusion: Predisposing factors for dural tear were, older age, prolonged surgery, and the years of physician training or resident experience appear to be a major risk.

Evaluation and management of small dural tears in primary lumbar spinal decompression and discectomy surgery

Incidental dural tear is one of the most common intraoperative complications in lumbar spine surgery. Yet, its technical management for the prevention of CSF leak is controversial. The technique of managing dural tears depends on the location of the dural tears as well on the length and anatomical characteristics of the dural tear. We propose an anatomical classification for small (less than one cm) dural tears and report on the outcome of managing these dural tears types using different technique for different type.62 patients underwent spinal dural repair after microdiscectomy or lumbar spinal decompression. Group 1 consisted of 20 patients, with Type I or mild dural tear who had tissue-glue coated collagen sponge or fibrin glue application. Group 2 comprised 21 patients with Type II or moderate dural tear who had both tissue-glue coated collagen sponge and fibrin glue application. Group 3 comprised 21 patients with Type III or severe dural tear who had polypropylene suture and tissue-glue coated collagen sponge and/or fibrin glue application. Evident postoperative CSF leak was used to determine the patient’s postoperative result. Postoperative CSF leak was not evident during a minimum 1 year follow up in group 1. Internal CSF leak was evident in group 2 (n = 3) and group 3 (n = 3) during same follow up. Three patients underwent re-do spinal surgery for CSF leak repair. We recommend different management technique depending on the type of tear. For type I, we recommend the use of tissue-glue coated collagen sponge or fibrin glue application, without dural suturing.

Body mass index predicts risk of complications in lumbar spine surgery based on surgical invasiveness

Background ContextObesity as a comorbidity in spine pathology may increase the risk of complications following surgical treatment. The body mass index (BMI) threshold at which obesity becomes clinically relevant, and the exact nature of that effect, remains poorly understood. PurposeIdentify the BMI that independently predicts risk of postoperative complications following lumbar spine surgery. Study Design/SettingRetrospective review of the National Surgery Quality Improvement Program (NSQIP) years 2011–2013. Patient SampleA total of 31,763 patients were undergoing arthrodesis, discectomy, laminectomy, laminoplasty, corpectomy, or osteotomy of the lumbar spine. Outcome MeasuresComplication rates. MethodsThe patient sample was categorized preoperatively by BMI according to the World Health Organization stratification: underweight (BMI <18.5), normal overweight (BMI 20.0–29.9), obesity class 1 (BMI 30.0–34.9), 2 (BMI 35.0–39.9), and 3 (BMI≥40). Patients were dichotomized based on their position above or below the 75th surgical invasiveness index (SII) percentile cutoff into low-SII and high-SII. Differences in complication rates in BMI groups were analyzed by Bonferroni analysis of variance (ANOVA) method. Multivariate binary logistic regression evaluated relationship between BMI and complication categories in all patients and in high-SII and low-SII surgeries. ResultsControlling for baseline difference in SII, Charlson Comorbidity Index (CCI) score, diabetes, hypertension, and smoking, complications significantly increased at a BMI of 35 kg/m2. The odds ratios for any complication (odds ratio [OR] [95% confidence interval {CI}]; obesity 2: 1.218 [1.020–1.455]; obesity 3: 1.742 [1.439–2.110]), infection (obesity 2: 1.335 [1.110–1.605]; obesity 3: 1.685 [1.372–2.069]), and surgical complication (obesity 2: 1.622 [1.250–2.104]; obesity 3: 2.798 [2.154–3.634]) were significantly higher in obesity classes 2 and 3 relative to the normal-overweight cohort (all p<.05). ConclusionThere is a significant increase in complications, specifically infection and surgical complications, in patients with BMI≥35 following lumbar spine surgery, with that rate further increasing with BMI≥40.

The effect of incidental dural lesions on outcome after decompression surgery for lumbar spinal stenosis: results of a multi-center study with 800 patients.

Incidental durotomy is one of the most common complications in lumbar spine surgery. There are conflicting reports whether a dural lesion is associated with an inferior outcome after lumbar decompression. This study analyzed the effect of incidental durotomy in this specific group of patients (Dura+) and compared the results with the remaining cohort without dural laceration (Dura-). This prospective multi-center study included 800 patients with lumbar spinal stenosis who underwent exclusive decompression surgery. All procedures were performed as part of a multi-center investigation at three highly specialized spine clinics. Outcome measures (ODI, EQ5D, VASback pain and VASleg pain) were obtained preoperatively as well as 3 and 12months after surgery. The effect of an incidental durotomy on the clinical outcomes was analyzed statistically between the two cohorts. An intraoperative dura lesion was recorded in 6.5% (n=52/800) of all cases. Both cohorts (Dura+ and Dura-) did not reveal any differences regarding patient demographics, risk factors, or co-morbidities at baseline. The length of the hospital stay was significantly longer for the Dura+ cohort (8.0 vs. 6.4days; p<0.01). After 12months, the Dura- cohort demonstrated a significantly greater improvement in VASback pain in comparison to the Dura+ cohort (Δ21.4 vs. Δ7.2 points; p<0.05). The differences for the remaining outcome measures were not statistically significant (p>0.05). The results of this study reveal that an incidental durotomy was associated with a significant increase in the patient's length of stay, and risk for re-intervention for the treatment of persisting CSF leakage. In contrast to previous reports which have investigated the effects of incidental durotomies on the clinical outcome after lumbar decompression surgery, our data further suggest a possible inferior outcome in terms of low back pain improvement in the Dura+ cohort, which became clinically apparent at the 12-month follow-up period. Future studies should investigate whether a more pronounced decompression required for adequate exposure and repair of a dural laceration may, ultimately, result in increased segmental instability and in clinically undesirable low back pain.

The Effect of Post Operative Sand Bag Pressure on CSF Leak after Spinal Surgery

Introduction Dural tears are most common complications of lumbar spine surgery and have been successfully managed using several techniques. These include primary repair, closed subarachnoid drainage, tissue grafting, fibrin-adhesive sealant, and bed rest. In this study a new method with post operative sand bag pressure to prevent Cerebrospinal fluid (CSF) leak is used. Methods A prospective study of 96 patients admitted to the Department of Neurosurgery at the Alsadr Teaching Hospital in Basrah/Iraq had CSF leak following different lumbar spine surgeries. Fifty two patients between March 2006 and March 2010 treated with the classical methods and 44 consecutive patients who had a post operative CSF leak between March 2010 and March 2013 treated with sand bag pressure. Results Classically treated group (13.5%) patients stopped CSF leak as compared with post operative sand bag pressure group (68.2%) patients stopped CSF leak in the first day. Regarding post operative complications, classically treated group had headache (55.8%), Photophobia (25.0%), nausea (32.7%), vomiting (15.4%), meningitis (5.8%) and revision surgery (9.6%) while post operative sand bag pressure group had headache (20.5%), Photophobia (9.1%), nausea (11.4%), vomiting (2.3%), meningitis (2.3%) and revision surgery (0%). Conclusions and bag pressure is an excellent method to decrease duration and complications of CSF leak.