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Issa TZ, Ezeonu T, Sellig M, Donnally CJ, Narayanan R, Karamian BA, Patel PD, Divi SN, Robinson WA, Shenoy K, Kepler CK, Vaccaro AR, Canseco JA. An Update in Complication Rates Associated With Anterior Lumbar Surgery: A Systematic Review and Meta-Analysis. Global Spine J 2024:21925682241279526. [PMID: 39197439 DOI: 10.1177/21925682241279526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2024] Open
Abstract
STUDY DESIGN Systematic Review and meta-analysis. OBJECTIVE To conduct an updated systematic review and meta-analysis of complications associated with different anterior fusion techniques/approaches and adjuvant resources (i.e., computed tomography angiography (CTA), rhBMP-2, and access surgeons). METHODS A systematic review was conducted from 1/1/2014-4/1/2024 for studies evaluating the incidence of complications associated with anterior lumbar procedures. Comparisons of complications were made between surgical approach, use of CTA, rhBMP-2, and access surgeons. Meta-analyses were conducted using a generalized linear mixed model. RESULTS 54 studies were included in the final analysis with 8066 patients and an average follow-up of 31.2 months. The overall complication rate associated with anterior lumbar surgery was 13.1%, including an intraoperative complication rate of 3.8%, postoperative complication rate of 7.4%, infection rate of 1.5%, and reoperation rate of 1.7%. Forest plot analysis showed no significant difference in overall complication rates between open and mini-open techniques, although mini-open techniques were associated with lower overall reoperation rates. The use of CTA was associated with an increase in intraoperative and overall complications, and the use of an access surgeon was associated with a decreased risk of reoperation. The use of rhBMP-2 was not associated with overall complication risk. CONCLUSIONS While anterior lumbar surgery provides numerous benefits, surgeons and patients alike should be aware of the complication and safety profile prior to surgery. High quality studies are warranted to help elucidate the true benefit of certain techniques and adjuvant resources in reducing complications.
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Affiliation(s)
- Tariq Z Issa
- Department of Orthopaedic Surgery, Icahn School of Medicine, The Mount Sinai Hospital, New York, NY, USA
| | - Teeto Ezeonu
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute Thomas Jefferson University, Philadelphia, PA, USA
| | - Mason Sellig
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute Thomas Jefferson University, Philadelphia, PA, USA
| | - Chester J Donnally
- Department of Orthopaedic Surgery, Texas Spine Consultants, Addison, TX, USA
| | - Rajkishen Narayanan
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute Thomas Jefferson University, Philadelphia, PA, USA
| | - Brian A Karamian
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Parthik D Patel
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute Thomas Jefferson University, Philadelphia, PA, USA
| | - Srikanth N Divi
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Kartik Shenoy
- Department of Orthopaedic Surgery, Mike O'Callaghan Military Medical Center, Nellis Air Force Base, NV, USA
| | - Christopher K Kepler
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute Thomas Jefferson University, Philadelphia, PA, USA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute Thomas Jefferson University, Philadelphia, PA, USA
| | - Jose A Canseco
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute Thomas Jefferson University, Philadelphia, PA, USA
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Lee D, Lee R, Weinreb J, Chalif E, Mohile N, Heyer JH, O'Brien J. Risk Factors for Surgical Site Infections After Single-Level Anterior Lumbar Interbody Fusion. Surg Infect (Larchmt) 2023. [PMID: 37327050 DOI: 10.1089/sur.2023.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
Abstract Background: Anterior lumbar interbody fusion (ALIF) has become an increasingly popular and effective treatment modality for various conditions of the lumbar spine. However, complications after this procedure can be costly. Surgical site infections (SSIs) are one of these types of complications. The present study identifies independent risk factors for SSI after single-level ALIF to identify high-risk patients better. Patients and Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried to identify single-level ALIF patients from 2005 to 2016. Multilevel fusions and non-anterior approach procedures were excluded. Mann-Pearson χ2 tests analyzed categorical variables, whereas one-way analysis of variance (ANOVA) and independent t-tests analyzed differences in mean values of continuous variables. Risk factors for SSI were identified via a multivariable logistic regression model. A receiver operating characteristic (ROC) curve was generated utilizing the predicted probabilities. Results: A total of 10,017 patients met inclusion criteria; 80 (0.80%) had developed SSI and 9,937 (99.20%) had not. On multivariable logistic regression models, class 3 obesity (p = 0.014), dialysis (p = 0.025), long-term steroid use (p = 0.010), and wound classification 4 (dirty/infected) (p = 0.002) all independently increased the risk for SSI in single-level ALIF. The area under the receiver operating characteristic curve (AUROC; C-statistic) was 0.728 (p < 0.001), indicating relatively strong reliability of the final model. Conclusions: Several independent risk factors including obesity, dialysis, long-term steroid use, and dirty wound classification all increased risk for SSI after single-level ALIF. By identifying these high-risk patients, surgeons and patients can have more informed pre-operative discussions. In addition, identifying and optimizing these patients prior to operative intervention may help to minimize infection risk.
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Affiliation(s)
- Danny Lee
- Department of Orthopaedic Surgery, University of Miami-Jackson Memorial Health System, Miami, Florida, USA
| | - Ryan Lee
- Department of Anesthesiology, Rutgers University Newark Health System, Newark, New Jersey, USA
| | - Jeffrey Weinreb
- Department of Orthopaedic Surgery, The George Washington University Hospital, Washington, DC, USA
| | - Eric Chalif
- The George Washington University School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Neil Mohile
- Department of Orthopaedic Surgery, University of Miami-Jackson Memorial Health System, Miami, Florida, USA
| | - Jessica H Heyer
- Department of Pediatric Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Joseph O'Brien
- Washington Spine and Scoliosis Institute, OrthoBethesda, Bethesda, Maryland, USA
- Department of Spine Surgery, Virginia Hospital Center, Arlington, Virginia, USA
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Scheyerer MJ, Herren C, Kühne C, Neufang J, Pieroh P, von der Höh NH. Surgical Treatment Strategies for Pyogenic Spondylodiscitis of the Thoracolumbar Spine. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2022; 160:621-628. [PMID: 34461670 DOI: 10.1055/a-1527-7939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Despite advances, the morbidity and mortality rates of patients with spondylodiscitis remains high, with an increasing incidence worldwide. Although conservative therapy has progressed, several cases require surgical intervention. However, the indication and opportunities for surgical treatment are still disputable. METHODS In a joint consensus, the members of the 'Spondylodiscitis' working group of the Spine Section of the German Society for Orthopaedics and Trauma Surgery considered current literature, particularly the newly published S2k guideline of the AWMF, and examined the surgical indications and treatment strategies for thoracolumbar spondylodiscitis. RESULTS Surgical intervention for spondylodiscitis is only required in a small percentage of patients. In studies comparing conservative and surgical therapies, most patients benefitted from surgery, regardless of the surgical technique selected. Presently, the standard procedure is a combined dorsoventral approach, in which a monolateral attempt should always be made. The choice of material (PEEK, titanium) for ventral support does not influence the clinical result.
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Affiliation(s)
- Max J Scheyerer
- Department of Orthopaedics and Trauma Surgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Germany
| | - Christian Herren
- Clinic for Trauma and Reconstructive Surgery, University Hospital Aachen, Germany
| | - Christian Kühne
- Trauma and Hand Surgery, Schön Clinic Hamburg-Eilbek, Germany
| | - Jörg Neufang
- Spinal Surgery, Professional Accidents Clinic Murnau, Germany
| | - Philipp Pieroh
- Clinic and Polyclinic for Orthopaedics, Trauma Surgery and Plastic Surgery, University of Leipzig Medical Faculty, Germany
| | - Nicolas H von der Höh
- Clinic and Polyclinic for Orthopaedics, Trauma Surgery and Plastic Surgery, University of Leipzig Medical Faculty, Germany
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Chen J, Xuan T, Lu Y, Lin X, Lv Z, Chen M. Outcome of one-stage percutaneous endoscopic debridement and lavage combined with percutaneous pedicle screw fixation for lumbar pyogenic spondylodiscitis. J Orthop Surg (Hong Kong) 2022; 29:23094990211065579. [PMID: 34911406 DOI: 10.1177/23094990211065579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND This study assessed the therapeutic effect of one-stage percutaneous endoscopic debridement and lavage (PEDL) combined with percutaneous pedicle screw fixation (PPSF) in the treatment of lumbar pyogenic spondylodiscitis. METHODS From March 2017 to October 2019, 51 patients diagnosed with pyogenic spondylodiscitis underwent PPSF followed by PEDL in our department. Biopsy specimens were examined for microorganisms and evaluated histopathologically. Clinical outcomes were assessed by physical examination, routine serological testing, visual analogue scale (VAS), Oswestry Disability Index (ODI) and imaging studies. RESULTS Of the enrolled patients, the operation time ranged from 90 min to 114 min every level with an average of 102 min, and the average drainage time ranged from 6 days to 10 days with an average of 7.4 days. All patients who complained of lower back pain symptoms were more relieved than before surgery. Causative pathogens were identified in 20 of 51 biopsy specimens; Staphylococcus aureus was the most prevalent. However, there were eight patients with postoperative complications. The mean follow-up was 25.0 ± 3.8 (range: 20-32) months. Inflammatory markers showed that infection was controlled. The VAS and ODI improved significantly. At the last follow-up, magnetic resonance imaging showed that the infected lesions had disappeared. CONCLUSION PEDL supplementing PPSF may be useful for patients with single-level lumbar pyogenic spondylodiscitis, as it is minimally invasive, especially for patients who cannot undergo conventional open surgery due to poor health or advanced age.
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Affiliation(s)
- Jianquan Chen
- Guangzhou University of Chinese Medicine, Guangzhou, PR China
- Department of Orthopaedics, Guang Dong Province Hospital of Traditional Chinese Medicine Zhuhai Branch, Zhuhai, Guangdong, China
| | - Tianhang Xuan
- Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong, China
| | - Yao Lu
- Department of Orthopaedics, Guang Dong Province Hospital of Traditional Chinese Medicine Zhuhai Branch, Zhuhai, Guangdong, China
| | - Xinyuan Lin
- Department of Orthopaedics, Guang Dong Province Hospital of Traditional Chinese Medicine Zhuhai Branch, Zhuhai, Guangdong, China
| | - Zhouming Lv
- Department of Orthopaedics, Guang Dong Province Hospital of Traditional Chinese Medicine Zhuhai Branch, Zhuhai, Guangdong, China
| | - Maoshui Chen
- Department of Orthopaedics, Guang Dong Province Hospital of Traditional Chinese Medicine Zhuhai Branch, Zhuhai, Guangdong, China
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Gregori F, Grasso G, Iaiani G, Marotta N, Torregrossa F, Landi A. Treatment algorithm for spontaneous spinal infections: A review of the literature. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2019; 10:3-9. [PMID: 31000972 PMCID: PMC6469318 DOI: 10.4103/jcvjs.jcvjs_115_18] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: Primary spinal infections are rare pathologies with an estimated incidence of 5% of all osteomyelitis. The diagnosis can be challenging and this might result in a late identification. The etiological diagnosis is the primary concern to determine the most appropriate treatment. The aim of this review article was to identify the importance of a methodological attitude toward accurate and prompt diagnosis using an algorithm to aid on spinal infection management. Methods: A search was done on spinal infection in some databases including PubMed, ISI Web of Knowledge, Google Scholar, Ebsco, Embasco, and Scopus. Results: Literature reveals that on the basis of a clinical suspicion, the diagnosis can be formulated with a rational use of physical, radiological, and microbiological examinations. Microbiological culture samples can be obtained by a percutaneous computed tomography-guided procedure or by an open surgical biopsy. When possible, the samples should be harvested before antibiotic treatment is started. Indications for surgical treatment include neurological deficits or sepsis, spine instability and/or deformity, presence of epidural abscess and failure of conservative treatment. Conclusion: A multidisciplinary approach involving both a spinal surgeon and an infectious disease specialist is necessary to better define the treatment strategy. Based on literature findings, a treatment algorithm for the diagnosis and management of primary spinal infections is proposed.
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Affiliation(s)
- Fabrizio Gregori
- Department of Human Neurosciences, Division of Neurosurgery, Sapienza University of Rome, Rome, Italy
| | - Giovanni Grasso
- Department of Biomedicine, Neurosciences and Advanced Diagnostics (Bi.N.D.), University of Palermo, Palermo, Italy
| | - Giancarlo Iaiani
- Department of Tropical and Infectious Diseases, Aou Policlinico Umberto I, Rome, Italy
| | - Nicola Marotta
- Department of Human Neurosciences, Division of Neurosurgery, Sapienza University of Rome, Rome, Italy
| | - Fabio Torregrossa
- Department of Biomedicine, Neurosciences and Advanced Diagnostics (Bi.N.D.), University of Palermo, Palermo, Italy
| | - Alessandro Landi
- Department of Human Neurosciences, Division of Neurosurgery, Sapienza University of Rome, Rome, Italy
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Anterior Lumbar Interbody Fusion With and Without an "Access Surgeon": A Systematic Review and Meta-analysis. Spine (Phila Pa 1976) 2017; 42:E592-E601. [PMID: 27669042 DOI: 10.1097/brs.0000000000001905] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A systematic review and meta-analysis. OBJECTIVE The aim of this study was to investigate the outcomes of anterior lumber interbody fusion (ALIF) with and without an "access surgeon." SUMMARY OF BACKGROUND DATA Anterior approaches for spine operations have become increasingly popular but may often involve unfamiliar anatomy and territory for spine surgeons, potentially placing the patient at risk to a greater proportion of approach-related complications. Thus, many spine surgeons require or prefer the assistance of an "access surgeon" to perform the exposure. However, there has been much debate about the necessity of an "access surgeon." METHODS A systematic search of six databases from inception to April 2016 was performed by two independent reviewers. Meta-analysis was used to pool overall rates, and compare the outcomes of ALIF with an access surgeon and without. RESULTS A total of 58 (8028 patients) studies were included in this meta-analysis. The overall intraoperative complications were similar with and without an "access surgeon." The overall pooled rate of arterial injuries [no access 0.44% vs. access 1.16%, odds ratio (OR) 2.67, P < 0.001], retrograde ejaculation (0.41% vs. 0.96%, OR 2.34, P = 0.005), and ileus (1.93% vs. 2.26%, OR 2.45, P < 0.001) was higher with an "access surgeon." However, the overall pooled rates of peritoneal injury (0.44% vs. 0.16%, OR 0.36, P = 0.034) and neurological injury (0.99% vs. 0.11%, OR 0.11, P < 0.001) were lower with an "access surgeon." Total postoperative complications (5.95% vs. 4.08%, OR 0.67, P < 0.001) were lower with an "access surgeon" along with prosthesis complications (1.59% vs. 0.89%, OR 0.56, P < 0.001) and reoperation rates (2.28% vs. 1.31%, OR 0.57, P < 0.001). CONCLUSION Compared with no access surgeon, the use of an access surgeon was associated with similar intraoperative complication rates, higher arterial injuries, retrograde ejaculation, ileus, and lower prosthesis complications, reoperation rates, and postoperative complications. In cases wherein exposure may be difficult, support from an "access surgeon" should be available. LEVEL OF EVIDENCE 1.
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