Morbidity and mortality in the surgical treatment of 10,242 adults with spondylolisthesis

Journal of Neurosurgery: Spine - Tập 13 Số 5 - Trang 589-593 - 2010
Charles A. Sansur1, Davis L. Reames2, Justin S. Smith2, D. Kojo Hamilton2,3, Sigurd Berven4, Paul A. Broadstone5, Theodore J. Choma6, Michael Goytan7, Hilali H. Noordeen8, Dennis R. Knapp9, Robert A. Hart10, Reinhard Zeller11, William F. Donaldson12, David W. Polly13, Joseph H. Perra14, Oheneba Boachie-Adjei15, Christopher I. Shaffrey2
11Department of Neurosurgery, University of Maryland Medical Center, Baltimore, Maryland;
22Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia
3University of Maryland, Baltimore
43Department of Orthopedic Surgery, University of California, San Francisco, California;
54Spine Surgery Associates, PC, Chattanooga, Tennessee;
65Orthopaedic Surgery, University of Missouri, Columbia, Missouri;
76Health Sciences Centre, Winnipeg, Manitoba, Canada;
87The Royal National Orthopedic Hospital, and the Great Ormond Street Children's Hospital, London, United Kingdom;
98Arnold Palmer Children's Hospital, Orlando, Florida;
109Orthopaedics Department, Oregon Health & Science University, Portland, Oregon;
1110Division of Orthopedic Surgery, Hospital for Sick Children, Toronto, Ontario, Canada;
1211University of Pittsburgh Physicians, Orthopedic Surgery, Pittsburgh, Pennsylvania;
1312Departments of Orthopaedic Surgery and Neurosurgery, University of Minnesota, Minneapolis;
1413Twin Cities Spine Center, Minneapolis, Minnesota; and
1514Hospital for Special Surgery, New York, New York

Tóm tắt

Object This is a retrospective review of 10,242 adults with degenerative spondylolisthesis (DS) and isthmic spondylolisthesis (IS) from the morbidity and mortality (M&M) index of the Scoliosis Research Society (SRS). This database was reviewed to assess complication incidence, and to identify factors that were associated with increased complication rates. Methods The SRS M&M database was queried to identify cases of DS and IS treated between 2004 and 2007. Complications were identified and analyzed based on age, surgical approach, spondylolisthesis type/grade, and history of previous surgery. Age was stratified into 2 categories: > 65 years and ≤ 65 years. Surgical approach was stratified into the following categories: decompression without fusion, anterior, anterior/posterior, posterior without instrumentation, posterior with instrumentation, and interbody fusion. Spondylolisthesis grades were divided into low-grade (Meyerding I and II) versus high-grade (Meyerding III, IV, and V) groups. Both univariate and multivariate analyses were performed. Results In the 10,242 cases of DS and IS reported, there were 945 complications (9.2%) in 813 patients (7.9%). The most common complications were dural tears, wound infections, implant complications, and neurological complications (range 0.7%–2.1%). The mortality rate was 0.1%. Diagnosis of DS had a significantly higher complication rate (8.5%) when compared with IS (6.6%; p = 0.002). High-grade spondylolisthesis correlated strongly with a higher complication rate (22.9% vs 8.3%, p < 0.0001). Age > 65 years was associated with a significantly higher complication rate (p = 0.02). History of previous surgery and surgical approach were not significantly associated with higher complication rates. On multivariate analysis, only the grade of spondylolisthesis (low vs high) was in the final best-fit model of factors associated with the occurrence of complications (p < 0.0001). Conclusions The rate of total complications for treatment of DS and IS in this series was 9.2%. The total percentage of patients with complications was 7.9%. On univariate analysis, the complication rate was significantly higher in patients with high-grade spondylolisthesis, a diagnosis of DS, and in older patients. Surgical approach and history of previous surgery were not significantly correlated with increased complication rates. On multivariate analysis, only the grade of spondylolisthesis was significantly associated with the occurrence of complications.

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Thông tin
Thông tin xuất bản

Journal of Neurosurgery: Spine

Tập 13 Số 5

589-593

Thông tin tác giả