SURGICAL COMPLICATIONS OF CERVICAL SPONDYLOTIC MYELOPATHY

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Gary Henry
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1 OBJECTIVE SURGICAL COMPLICATIONS OF CERVICAL SPONDYLOTIC MYELOPATHY Matamalas A, Plano X, Pellisé F,García de Frutos A, Casamitjana J. Spine Unit. Hospital Vall d Hebrón. Barcelona To assess the rate of complications associated with cervical spondylotic myelopathy (CSM) surgery and to evaluate the influence of the approach on complication rates. METHODS Study design: A retrospective single-center study. Sample: All patients operated because of CSM between 2005 and 2010 with at least one year followup were reviewed. Collected data: Demographic data; preoperative co-morbidities; medical, surgical and mechanical complications and re-intervention during follow up.

2 RESULTS: DESCRIPTIVES 221 patients (237 surgeries). Mean age: 52.2 years (SD±13.55). 66.5% men; 37.1% smokers. 78.3% co-morbidities (mean co-morbidities per patient=2.07). Mean operated levels: 3 (min=1 / max= 5). Mean hospital stay: 9.8 days (SD=±8.3). Mean follow-up: 41 months. CO-MORBIDITY % OF AFFECTED PATIENTS Hypertension 38.0 Respiratory disease 23.5 Depression 16.7 Diabetes mellitus 16.7 Other neurological diseases 13.1 Ischemic cardiopathy 10.9 Alcoholism 10.4 Cardiac arrhythmias 8.1 Peripheral vascular disease 6.3

3 RESULTS: DESCRIPTIVES APPROACH TYPE OF SURGERY Posterior approach: 32,6% Anterior approach: 66,2% Diskectomy Combined approach: 1,7% 32,6% 50,0% Corpectomy 9,3% 8,1% Combined (diskectomy + corpectomy) Laminectomy

4 RESULTS: COMPLICATION RATE: No complications: 73,4% Minor: 14,8% Major: 11,8% Increase hospital stay >2SD: 40,7% Needs an invasive procedure to treat it: 29,6% It has some permanent sequela: 29,7% % PATIENTS AFECTED DEPENDIG OF COMPLICATION TYPE: Medical complication: 22,8% Related to surgery: 6,8% Related to implant: 3,8% *** Both medical and related to surgery complications:13% EVOLUTION OF COMPLICATIONS: Totally recovered: 86,7% With some kind of sequela: 13,3% (8 patients) MORTALITY RATE: 0,4% (1 patient)

5 RESULTS: INCIDENCE OF COMPLICATIONS MEDICAL COMPLICATIONS COMPLICATION % AFFECTED PATIENTS Respiratory insufficiency 4.2 Dysphagia 4.2 Urinary tract infection 3.4 Pulmonary infection 2.1 Sepsis 1.3 Stroke 1.3 NEUROLOGICAL COMPLICATIONS COMPLICATION Postoperative worsening of mielopathy % AFFECTED PATIENTS 0.4 Radicular Pain 3.4 Radicular sensitive impairment 1.7 Radicular motor impairment 3.0 The most frequent affected roots were: C6 (1.9%) C5 (1.5%)

RESULTS: INCIDENCE OF COMPLICATIONS WOUND COMPICATIONS COMPLICATION Dehiscence Wound infection % AFFECTED PATIENTS 3.80 (Deep: 1.3%) 2.90 (Deep:2.1%) Hematoma 2.

6 RESULTS: INCIDENCE OF COMPLICATIONS WOUND COMPICATIONS COMPLICATION Dehiscence Wound infection % AFFECTED PATIENTS 3.80 (Deep: 1.3%) 2.90 (Deep:2.1%) Hematoma 2.50 Mechanical complications: 3.8% How many patients need a second surgery during follow-up? 9.3% Why? Implant failure (pseudo): 0.4% Debridement: 2.5% New worsening of myelopathy at the same or different level: 6.3%

7 RESULTS ANTERIOR VS POSTERIOR APPROACH ANTERIOR (n=157) POSTERIOR (n=75) Statistical sig (p) Age (years) Hospital stays (days) Num. instrumented levels Num. co-morbidities per patient 1,99 2,04 0,16 Major complications (%) Medical complications (%) Surgical complications (%) Radicular neurological impairment (%) Radicular pain(%)

8 RESULTS We didn t find differences between the number of instrumented levels and different kinds of complications analyzed. Older patients had higher rates of medical complications postoperatively (p=0.001).

9 CONCLUSIONS One quarter of patients operated on because of CSM developed some kind of postoperative complication: Minor complications 11,8% Major complications 14,8% Recovered 86,7% / Complication with sequela 13,3% Older patients had a higher risk of medical complications. Patients operated on by posterior approach had a higher risk of local neurological problems and wound complications.

10 DISCLOUSURE Depuy Spine (Grant/Research support;consultant; speakers boureau) K2M (Grant/Research support) Biomet (Grant/Research support)

Cervical Spine Surgery: Approach related outcome

Cervical Spine Surgery: Approach related outcome Hez Progect Israel 2016 Ran Harel, MD Spine Surgery Unit, Department of Neurosurgery, Sheba Medical Center, Ramat-Gan, Israel Sackler Medical School, Tel-Aviv