neurological problems after spinal fusionneurological problems after spinal fusion

A review found complication rates ranged from 0 to 33.3% for MI-TLIF and 1.616.7% for MI-PLIF with radiculopathy and cerebrospinal fluid leakage being the most common etiologies [8]. RW was the major contributor in writing the manuscript. 2014;85(10):92942. On the supply side, the possibilities of care have grown with improvements in diagnostic techniques, imaging, methods of treatment, equipment and materials. After spinal cord . Clin Neurol Neurosurg. Underreporting of data could be due to the fact that our estimates are largely based on claims data, which is compiled to maximize the billing process. These data may aid the implementation of preventative measures among identified high-risk patients. In the USA, around 80% of the population will experience back pain during their lifetime [1], many of whom will require surgical intervention. Comparison of symptomatic cerebral spinal fluid leak between patients undergoing minimally invasive versus open lumbar foraminotomy, discectomy, or laminectomy. There are also patient variables, including age, general level of health, and previous surgical procedures/lumbar fusions. In our study, we found three patients with unilateral lower extremity symptoms prior to surgery. [4] demonstrated in a study on dogs that when compressions to the spinal cord last for 6 h, there are no neurological recovery and progressive spinal cord necrosis. There were 67 patients who suffered from neurologic deficit following their revision procedures, with 39 of 67 (58.21%) suffering no morbidity and 28 of 67 (41.79%) suffering morbidity. Spine (Phila Pa 1976). Among these patients, 67 patients (0.88%) developed a postoperative neurological deficit with an unadjusted odds ratio of 1.61 (95% CI, 1.252.07, P < .05). These techniques caused a major paradigm shift in spine surgery by proving that decreased operating exposure can translate to clinical benefits, such as decreased rates of CSF leaks, infection, and length of stay [2, 3, 4]. Carreon et al. Surgical outcomes for minimally invasive vs open transforaminal lumbar interbody fusion: an updated systematic review and meta-analysis. Postoperative neurologic complications during spinal fusion surgery: incidence and trends. the contents by NLM or the National Institutes of Health. However, if the spinal cord is compressed, this affects how the nerves communicate and could lead to tremors. Cervical spinal cord injury. One such complication is a Kirschner wire (K-wire) fracture during MI-TLIF. Claudication: Causes, Symptoms and Treatment - Cleveland Clinic: Every Back pain can also hurt more than just your body. For example, a VWS of more than14 (odds ratio = 3.98) would contribute a higher risk than a score of 5 to 14 (odds ratio = 2.99). Kim M-C, Chung H-T, Cho J-L, Kim D-J, Chung N-S. Factors affecting the accurate placement of percutaneous pedicle screws during minimally invasive transforaminal lumbar interbody fusion. Sometimes, surgery is needed to stabilize the spinal cord after acute SCI. Zhao Q, Zhang H, Hao D, Guo H, Wang B, He B. The purpose of such a protocol, which can be developed using the data presented in this study, would be to determine the risk level a patient undergoing spinal revision surgery would have for sustaining a deficit. The effect of local intraoperative steroid administration on the rate of postoperative dysphagia following ACDF: a study of 245,754 patients. Post-operative nerve injuries after cervical spine surgery J Bone Joint Surg Am. There were 376 patients (0.29%) who died during the hospital stay. as delaying care may lead to permanent neurological injury. . 1Department of Neurosurgery, Northwestern University, 676 N Saint Clair, NMH/Arkes Family Pavilion Suite 2210, Chicago, IL 60611 USA, 2Institute for Public Health and Medicine (IPHAM), Center for Healthcare Studies, Northwestern University, Chicago, IL USA, 3Northwestern University, Chicago, IL USA. The main cause of weaknesses was internal fixation problems, epidural hematomas, insufficient decompressions, and nerve root edemas. A timely diagnosis and urgent management of neurologic complications are very important when helping patients recover from neurological deficits after lumbar spine surgeries. Perez-Cruet MJ, Fessler RG, Perin NI. Because of the cauda equina nerves, you can move and feel sensations in your legs and urinary bladder. Medications and therapy can help prevent and treat these problems. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. Multivariable analysis of the same patient characteristics shown in Table 5 yielded slightly different results. Further systematic review of other minimally invasive spine surgeries will be necessary to better understand complication rates across alternative procedures, diagnoses, and patient populations. The treatment for tremor-related back issues may . . If you have foot drop, the front of your foot might drag on the ground when you walk. HHS Vulnerability Disclosure, Help Phan K, Rao PJ, Kam AC, Mobbs RJ. Perez-Cruet MJ, Hussain NS, White GZ, Begun EM, Collins RA, Fahim DK, Hiremath GK, Adbi FM, Yacob SA. compared open decompressive laminectomy with minimally invasive lumbar laminectomy for lumbar stenosis, finding complication rates of 16.1% in the open group compared with 7.9% in the minimally invasive cohort [53]. A systematic review describing MISD for degenerative spondylolisthesis found an overall complication rate of 1.6% and an overall reoperation rate of 4.5% [55]. Abbreviations: LOS, length of stay; ND, neurological deficit; VWS, van Walraven score. We identified several risk factors contributing to increased odds of new onset depression and/or anxiety after spine fusion surgery. Using those with a VWS of less than 5 as the reference group, the odds of morbidity was 4.09 (95% CI, 3.464.83, P < .05) in the group that scored 5 to 14 and 8.46 (95% CI, 5.7812.38, P < .05) in the group that scored greater than 14. 2014;41:322. official website and that any information you provide is encrypted Google Scholar. Additionally, specific patient characteristics might influence the rates and variability of complications following spine surgery including body mass and age. c The left L3 pedicle screw was removed after reoperation. RW, HL, and CL designed this study. In this study, we found that the incidence rate of lower extremity weaknesses was 0.74% (30/4078) after posterior lumbar spine fusion surgeries. Minimally invasive transforaminal lumbar interbody fusion for spondylolisthesis and degenerative spondylosis: 5-year results. [3] showed that in a study of 37 patients suffering neurological injury after spinal fusion surgery, a malposition of screws resulted in 11 injuries and 9 patients were affected by the placement of instrumentation [10,11,12,13]. Carreon LY, Puno RM, Dimar JR 2nd, Glassman SD, Johnson JR. Perioperative complications of posterior lumbar decompressions and arthrodesis in older adults. An aggregate percentile could be compiled using all risk factors that we have determined to be significant. Your US state privacy rights, We counted the patients at our center that underwent posterior lumbar fusion surgery between January 2009 and December 2018. However, studies investigating outcomes in obese populations compared with normal weight populations undergoing MI-TLIF have found no significant difference in complications [28], with some studies suggesting decreased complications in obese patients undergoing minimally invasive surgery compared with open TLIF [47]. These complications can manifest as radiculopathies, lower extremity weaknesses, spinal cord compressions, or postoperative neuropathic pains. Lack of specific deficits makes it difficult to draw specific conclusions on the causes of complications and requires a prospective study. Int. Iatrogenic neurologic deficits and lower extremity weaknesses were rare complications after posterior lumbar spine fusion surgeries, but important to recognize and manage. Revision spine surgery is defined as a secondary surgical procedure at the same site as a previous spine surgery. Using private insurance as the reference group, the odds of morbidity with Medicare was 1.67 (95% CI, 1.401.99, P < .05) and the odds of morbidity with Medicaid was 1.85 (95% CI, 1.332.56, P < .05). Rates of new neurologic deficit associated with spine surgery based on 108419 procedures: a report of the Scoliosis Research Society Morbidity and Mortality Committee. In summary, our study reveals that iatrogenic neurological deficits and lower extremity weaknesses after posterior lumbar spine fusion surgeries were rare complications, but important to recognize and manage. Obesity and spine surgery: relation to perioperative complications. Pathophysiology of spinal cord injuries: recovery after immediate and delayed decompression. Minimally invasive spine surgery has been shown to have decreased blood loss, hospital stay, medical and surgical complications, and equivalent patient satisfaction rates as traditional methods [42]. What You Need to Know Cervical myelopathy results from compression of the spinal cord in the neck (cervical area of the spine). Multivariable analysis of predictors of neurologic deficit in all spinal procedures. Two samples were created for analysis (all spinal procedures and revision spinal procedures). Although minimally invasive spine surgery has a favorable complication profile when compared with open methods, extensive studies continue to reveal that these newer techniques have distinct complications. Data were extracted from the SID from 2008 to 2011 because POA reporting before 2008 was not mandatory, and data after 2011 were not available. With payer type, only Medicare had a significant odds of morbidity at 1.30 (95% CI, 1.091.56, P < .05). Incidence of graft extrusion following minimally invasive transforaminal lumbar interbody fusion. Adjacent Segment Disease (ASD) simply means that the area above and below the fusion is getting overloaded (3). The impact of neurological deficits on in-hospital morbidity following revision procedures was also calculated. Lumbar Fusion for Spinal Fusion Complications Years - Regenexx Colorado Any cases fewer than 10 were replaced by an asterisk in accordance with Healthcare Cost and Utilization Project regulations to limit possible patient identification. https://doi.org/10.1186/s13018-020-01948-4, DOI: https://doi.org/10.1186/s13018-020-01948-4. Minimally invasive versus open transforaminal lumbar interbody fusion for treatment of degenerative lumbar disease: systematic review and meta-analysis. Singh K, Nandyala SV, Marquez-Lara A, Cha TD, Khan SN, Fineberg SJ, Pelton MA. Incidence, prevalence, costs, and impact on disability of common conditions requiring rehabilitation in the United States: stroke, spinal cord injury, traumatic brain injury, multiple sclerosis, osteoarthritis, rheumatoid arthritis, limb loss, and back pain [published online January 28, 2014]. Another health facility including long term care, Household income (Median income for patient's zip code), Refusion of spine, not otherwise specified, Refusion of other cervical spine, anterior column, anterior technique, Refusion of other cervical spine, posterior column, posterior technique, Refusion of dorsal and dorsolumbar spine, anterior column, anterior technique, Refusion of dorsal and dorsolumbar spine, posterior column, posterior technique, Refusion of lumbar and lumbosacral spine, anterior column, anterior technique, Refusion of lumbar and lumbosacral spine, posterior column, posterior technique, Refusion of lumbar and lumbosacral spine, anterior column, posterior technique, Refusion of spine, not elsewhere classified, Fusion or refusion of 9 or more vertebrae. A retrospective analysis of elderly patients revealed a complication rate of 11.1% and all complications resolving by the 1-year follow-up, suggesting minimally invasive spinal surgery may be safe in elderly populations [48]. Signs and symptoms of neurogenic bladder may include: Loss of bladder control . Headaches. 1995;77:10429. Cookies policy. 3. Included study characteristics and corresponding complication data for MI-TLIF, Dermal excoriation due to surgical draping, Vertebral canal narrowing (POD 1, bony fragment), Vertebral canal narrowing (POD 16, pedicle fracture), Mechanical dislocation of proximal fusion system, Cerebrospinal fluid leak (intraoperatively), Incidental durotomy; cerebrospinal fluid leak (lasted 35days post-op), overlying fascia closed tightly, supine bed rest few days post-operatively, Screw malposition; pneumonia; cage migration, Graft site infection (iliac crest); Incidental durotomy, Cage subsidence; progression of spondylolisthesis, Cage subsidence; broken screw (right S1 pedicle), Cage migration; progression of spondylolisthesis, Cage subsidence; screw loosening (B/L L4 pedicle). Revision procedures accounted for 5.84% of all spine procedures in a total of 7645 patients. Bridwell KH, Lenke LG, Baldus C, Blanke K. Major intraoperative neurologic deficits in pediatric and adult spinal deformity patients: incidence and etiology at one institution. Sclafani JA, Kim CW. Daubs et al. [14] reported in their study that CT scans detected a rate of screw malposition as 3.9%. Spina bifida (myelomeningocele): This disorder occurs when the spine doesn't completely develop during the first month of pregnancy. Lee TH, Marcantonio ER, Mangione CM, et al. In theory, this protocol would compose a system in which patients would receive points for factors associated with higher risk of postoperative spinal cord injury. A retrospective study comparing percutaneous and open pedicle screw fixation for thoracolumbar fractures with spinal injuries. The morbid group had an average age of 58.81 years, whereas the nonmorbid group had an average age of 56.07 years. a Postoperative x-ray. Transverse myelitis - Symptoms & causes - Mayo Clinic Can Spinal Fusion Cause Paralysis? Cervical Spine (Neck): What It Is, Anatomy & Disorders - Cleveland Clinic The information gained from this analysis will underscore the impact of postoperative neurological complications after revision surgeries. National Library of Medicine The most common type of surgery in adults is a posterior spinal fusion with instrumentation (artificial implants). b X-ray after the left L4 pedicle screw was adjusted during surgery. Patients insured through Medicaid were also at increased odds of developing neurological deficits, with an odds ratio of 1.421 (95% CI, 1.0251.969, P < .05). The https:// ensures that you are connecting to the Foot drop isn't a disease. These complications vary based on the exact MIS procedure and indication. Open surgery for adult scoliosis has been described as having very high complication rates, up to 66% [49]. . Numerous studies show that the use of image-guided technologies to identify pedicle screw placements could significantly decrease the pedicle breach rate during a procedure [15, 16]. Data on revision spine procedures were extracted from the California State Inpatient Database for years 2008 to 2011. Minimally invasive versus open transforaminal lumbar interbody fusion: a meta-analysis based on the current evidence. Thirty patients (30/4078, 0.74%) required a secondary surgery because of lower extremity weaknesses after posterior lumbar spine fusion surgery. 2020;81:2906. In the bivariate analysis of all spinal procedures shown in Table 1, there were 7645 (5.84%) revision procedures. Patients were excluded if the iatrogenic neurological deficits were ameliorated by traditional methods of treatment, or secondary surgery was needed because of other non-neurogenic factors, i.e., wound exudations, wound infections, or foreign body residues. Any direct injury to the spinal cord during procedures is classified as a perioperative spinal cord injury. In patients who suffered from neurological deficit, the rate of morbidity was exceedingly higher than those who did not (10.65% vs 41.79%). A Systematic Review of Complications Following Minimally Invasive Spine Ghobrial GM, Williams KA Jr, Arnold P, Fehlings M, Harrop JS. Obesity and self-reported outcome after minimally invasive lumbar spinal fusion surgery. Kukreja S, Haydel J, Nanda A, Sin AH. Postoperative neurological complications are a major problem after spine surgery and range from minor paresthesia to quadriplegia. Xie Q, et al. Well known problems after spinal fusion include failure of the bone healing, a condition called pseudarthrosis. Twenty-seven patients (90%) got improved muscle strength after their secondary surgery. National Library of Medicine Indications for MI-TLIF included degenerative disk disease, spondylolisthesis, and vertebral canal stenosis as the indicators for surgery. Spinal problems rarely cause tremors. Final variables included in the multivariable models were based on initial statistical significance in the bivariate analysis with a .05 level of significance, clinical plausibility, and effect on model C statistics. In the review of the literature, 31 articles describing MI-TLIF were identified but only 26 articles reported complications. After general anesthesia was induced, the initial incisions were made. Minimally invasive transforaminal lumbar interbody fusion: a review of techniques and outcomes. Spine (Phila Pa 1976). official website and that any information you provide is encrypted The mortality model failed to produce any meaningful numbers because the number of patients who developed neurological deficits and died in the hospital was small; thus, we did not report the numbers. Iatrogenic neurologic deficits after surgery are rare, but the most feared complications of spinal surgery. The site is secure. J Orthop Surg Res 15, 435 (2020). Diebo BG, Passias PG, Marascalchi BJ, et al. In our analysis of 130868 spinal procedures, 69622 patients (53.2%) were women. There were 12 men and 18 women with an average age of 62.9years (62.9 12.7years). Transverse myelitis is an inflammation of both sides of one section of the spinal cord. Causes of myelopathy include spinal stenosis, spinal trauma and spinal infections, as well as autoimmune, oncological, neurological and congenital disorders. After running a macro, a set of options in Microsoft Excel that can automate tasks, to calculate VWS (an Elixhauser comorbidity index quantifies disease burden in patients), we ran an initial bivariate analysis using 2 for categorical variables and t test for continuous variables. There may be positive, therapeutic effects to subsequent, active surgical exploration. The patients symptoms (numbness, weakness) were relieved after reoperation, A 26-year-old male experienced numbness in his right lower extremity and had grade 1 hip flexion muscle strength a day after a PLF and an L2 pedicle subtraction osteotomy due to ankylosing spondylitis. Li Y-B, Wang X-D, Yan H-W, Hao D-J, Liu Z-H. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. This study had several limitations that may have affected our final conclusions. A spinal fusion is a common type of complex spinal surgery that can help with chronic back pain in certain situations. Lower extremity motor weaknesses occurred the day after surgery, and an acute epidural hematoma was found on an MRI. CT scans and MRIs are mainstream examinations that help in the diagnosis of neurological deficits. The most common area of the spine affected is the lumbar region. Adv Tech Stand Neurosurg. The most frequently documented MI-TLIF complications in current published literature were radiculitis, screw malposition, and incidental durotomy. Development and validation of a risk calculator for prediction of cardiac risk after surgery. 1). 1, 2, 3, and 4). These data were then used to calculate the total incidence of postoperative neurological deficits following all spinal procedures and following revision spine procedures only. Of patients who developed neurological deficits, 16 patients (2.16%) died during the hospital stay. We utilized PubMed as the primary engine and attempted to include broad search terms, but it is possible that we did not identify all articles published meeting inclusion criteria. b CT scan showed that the left L3 pedicle screw intruded the inner pedicle wall (arrow). 2016;41(13):10848. In total, the studies referenced 89 (range 1 to 21) discrete complications for MI-TLIF. Before Common Problems After Spinal Fusion - Home - Premia Spine Only three patients who had had epidural hematomas had lower extremity muscle strength (grade 2) by day 3, but they similarly were recorded as having grade 4 or normal muscle strength after secondary surgery. Patients were included if one or more of the following symptoms were present: (1) the muscle strength of their lower limbs had declined by more than three grades after posterior lumbar fusion surgery and had not improved with traditional methods of treatment (rest; intravenous infusions of mannitol and methylprednisolone), and (2) the muscle strength of their lower limbs had declined suddenly to grade 0 or 1 after fusion surgery. Neurological disorders . All postoperative neurological complications can result in subpar patient outcomes, complicate recovery, and increase overall health care costs.2. Several studies have reported that the prevalence of deficits ranges from 0.8 to 6.1% [1, 2]. Dakwar E, Cardona RF, Smith DA, Uribe JS. Abbreviations: CI, confidence interval; n, number of patients; NA, not applicable; REF, reference; SD, standard deviation; *, no data available. First described in 2002 by Foley and Gupta, MI-TLIF was reported to have decreased paraspinous tissue damage, without weakening the effectiveness of the spinal fusion [43]. Clinical sequelae after rhBMP-2 use in a minimally invasive transforaminal lumbar interbody fusion. Maserati MB, Tormenti MJ, Panczykowski DM, Bonfield CM, Gerszten PC. The most common indications that further surgery was required were where there were cases of lumbar herniated discs, spondylolisthesis, scoliosis, and lumbar stenosis (Table1). Phillips FM, Isaacs RE, Rodgers WB, Khajavi K, Tohmeh AG, Deviren V, Peterson MD, Hyde J, Kurd M. Adult degenerative scoliosis treated with XLIF: clinical and radiographical results of a prospective multicenter study with 24-month follow-up. The first limitation is that our estimates were based on data with significant underreporting of postoperative neurological complications, which may have been responsible for the low estimates of incidence reported in the study. Following decompression, common complications include dural tears and delayed pseudomeningocele formation [6, 7]. Provided by the Springer Nature SharedIt content-sharing initiative. Within each sample, demographic data were gathered about all patients, regardless of whether they developed postoperative neurological deficits. Six articles specifically focused on one type of complication, including graft extrusion, incidental durotomy, pedicle breach, cage subsidence, superior facet violation, and screw malposition.