scholarly journals Two cases of supratentorial lobar intracranial hemorrhage following lumbar decompression and stabilization

2021 ◽  
Vol 12 ◽  
pp. 221
Author(s):  
Ahmed Kashkoush ◽  
Vikram Chakravarthy ◽  
Mark Bain ◽  
Iain Kalfas ◽  
Michael Steinmetz
Keyword(s):  
Lumbar Spine ◽  
Intracranial Hemorrhage ◽  
Spine Surgery ◽  
Lumbar Spine Surgery ◽  
Dural Tear ◽  
Case Description ◽  
Lumbar Surgery ◽  
Left Temporal Lobe ◽  
Intracranial Hemorrhages ◽  
Instrumented Fusion

Background: Lumbar spine surgery with or without intraoperative dural tear (DT) may contribute to postoperative subdural hematomas and/or cerebellar intracranial hemorrhages (ICHs). Here, we present two patients, one with and one without an intraoperative DT occurring during lumbar surgery, both of whom developed acute postoperative supratentorial ICHs. Case Description: Two patients developed supratentorial lobar ICH following lumbar decompressions and fusion. The first patient, without an intraoperative DT, developed multiple ICHs involving the left cerebellum and left temporal lobe. The second patient, following an L4-5 decompression/instrumented fusion involving a DT, postoperatively developed a large right frontal ICH. Conclusion: Here, two patients undergoing lumbar spine surgery with/without DT subsequently developed significant ICH.

scholarly journals A Case of Intracranial Hemorrhage Following a Incidental Dural Tear during Lumbar Spine Surgery

2008 ◽  
Vol 57 (4) ◽  
pp. 563-566 ◽  
Author(s):  
Tetsuya Tanaka ◽  
Taichi Saito ◽  
Isao Saikawa ◽  
Tsutomu Irie ◽  
Junya Ogata ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Intracranial Hemorrhage ◽  
Spine Surgery ◽  
Lumbar Spine Surgery ◽  
Dural Tear

Spinal anesthesia in contemporary and complex lumbar spine surgery: experience with 343 cases

2021 ◽  
pp. 1-8
Author(s):  
Jeffrey M. Breton ◽  
Calvin G. Ludwig ◽  
Michael J. Yang ◽  
T. Jayde Nail ◽  
Ron I. Riesenburger ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Spinal Anesthesia ◽  
Spine Surgery ◽  
Outcome Data ◽  
Lumbar Spine Surgery ◽  
Class Iii ◽  
Instrumented Fusion ◽  
Fusion Procedure ◽  
Physical Status Classification ◽  
Wide Range

OBJECTIVE Spinal anesthesia (SA) is an alternative to general anesthesia (GA) for lumbar spine surgery, including complex instrumented fusion, although there are relatively few outcome data available. The authors discuss their experience using SA in a modern complex lumbar spine surgery practice to describe its utility and implementation. METHODS Data from patients receiving SA for lumbar spine surgery by one surgeon from March 2017 to December 2020 were collected via a retrospective chart review. Cases were divided into nonfusion and fusion procedure categories and analyzed for demographics and baseline medical status; pre-, intra-, and postoperative events; hospital course, including Acute Pain Service (APS) consults; and follow-up visit outcome data. RESULTS A total of 345 consecutive lumbar spine procedures were found, with 343 records complete for analysis, including 181 fusion and 162 nonfusion procedures and spinal levels from T11 through S1. The fusion group was significantly older (mean age 65.9 ± 12.4 vs 59.5 ± 15.4 years, p < 0.001) and had a significantly higher proportion of patients with American Society of Anesthesiologists (ASA) Physical Status Classification class III (p = 0.009) than the nonfusion group. There were no intraoperative conversions to GA, with infrequent need for a second dose of SA preoperatively (2.9%, 10/343) and rare preoperative conversion to GA (0.6%, 2/343) across fusion and nonfusion groups. Rates of complications during hospitalization were comparable to those seen in the literature. The APS was consulted for 2.9% (10/343) of procedures. An algorithm for the integration of SA into a lumbar spine surgery practice, from surgical and anesthetic perspectives, is also offered. CONCLUSIONS SA is a viable, safe, and effective option for lumbar spine surgery across a wide range of age and health statuses, particularly in older patients and those who want to avoid GA. The authors’ protocol, based in part on the largest set of data currently available describing complex instrumented fusion surgeries of the lumbar spine completed under SA, presents guidance and best practices to integrate SA into contemporary lumbar spine practices.

scholarly journals Intracranial hemorrhage following lumbar spine surgery

2012 ◽  
Vol 21 (10) ◽  
pp. 2091-2096 ◽  
Author(s):  
Mahmoud Reza Khalatbari ◽  
Iraj Khalatbari ◽  
Yashar Moharamzad
Keyword(s):  
Lumbar Spine ◽  
Intracranial Hemorrhage ◽  
Spine Surgery ◽  
Lumbar Spine Surgery

scholarly journals Predictive Factors for Dural Tear in Lumbar Spine Surgery

2015 ◽  
Vol 13 (1) ◽  
pp. 35-40
Author(s):  
Abdelaal Abdelbaky ◽  
Walid Younes ◽  
Mohammed Adawi
Keyword(s):  
Lumbar Spine ◽  
Spine Surgery ◽  
Predictive Factors ◽  
Lumbar Spine Surgery ◽  
Dural Tear

scholarly journals Long-term impact of obesity on patient-reported outcomes and patient satisfaction after lumbar spine surgery: an observational study

2021 ◽  
Vol 34 (1) ◽  
pp. 73-82 ◽  
Author(s):  
Christine Park ◽  
Alessandra N. Garcia ◽  
Chad Cook ◽  
Christopher I. Shaffrey ◽  
Oren N. Gottfried
Keyword(s):  
Patient Satisfaction ◽  
Lumbar Spine ◽  
Spine Surgery ◽  
Patient Reported Outcomes ◽  
Normal Weight ◽  
Lumbar Spine Surgery ◽  
Morbidly Obese ◽  
Lumbar Surgery ◽  
Patient Reported

OBJECTIVEObese body habitus is a challenging issue to address in lumbar spine surgery. There is a lack of consensus on the long-term influence of BMI on patient-reported outcomes and satisfaction. This study aimed to examine the differences in patient-reported outcomes over the course of 12 and 24 months among BMI classifications of patients who underwent lumbar surgery.METHODSA search was performed using the Quality Outcomes Database (QOD) Spine Registry from 2012 to 2018 to identify patients who underwent lumbar surgery and had either a 12- or 24-month follow-up. Patients were categorized based on their BMI as normal weight (≤ 25 kg/m2), overweight (25–30 kg/m2), obese (30–40 kg/m2), and morbidly obese (> 40 kg/m2). Outcomes included the Oswestry Disability Index (ODI) and the visual analog scale (VAS) for back pain (BP) and leg pain (LP), and patient satisfaction was measured at 12 and 24 months postoperatively.RESULTSA total of 31,765 patients were included. At both the 12- and 24-month follow-ups, those who were obese and morbidly obese had worse ODI, VAS-BP, and VAS-LP scores (all p < 0.01) and more frequently rated their satisfaction as “I am the same or worse than before treatment” (all p < 0.01) compared with those who were normal weight. Receiver operating characteristic curve analysis revealed that the BMI cutoffs for predicting worsening disability and surgery dissatisfaction were 30.1 kg/m2 and 29.9 kg/m2 for the 12- and 24-month follow-ups, respectively.CONCLUSIONSHigher BMI was associated with poorer patient-reported outcomes and satisfaction at both the 12- and 24-month follow-ups. BMI of 30 kg/m2 is the cutoff for predicting worse patient outcomes after lumbar surgery.

Unintended durotomy during degenerative lumbar spine surgery in patients aged 60 years and older – incidence and risk factors

2020 ◽  
Vol 99 (2) ◽  
pp. 67-71
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Lumbar Spine ◽  
Spine Surgery ◽  
Type Ii Diabetes ◽  
Significant Risk ◽  
Type Ii Diabetes Mellitus ◽  
Lumbar Spine Surgery ◽  
Type Ii ◽  
Dural Tear

Introduction: Unintended perioperative dural tear is a common complication in spine surgery. Methods: Retrospective analysis of patients over 60 years of age who underwent surgery for degenerative disease of the lumbar spine at the Department of Neurosurgery (University Hospital in Martin) from January 2016 to December 2017. Incidence of incidental perioperative durotomy was analyzed. We analyzed selected risk factors − gender, ASA (American Society of Anesthesiologists), surgical diagnosis, type of surgical performance, range of surgical procedure, revision surgery and comorbidities. The results were statistically evaluated using descriptive statistics and Fisher›s test. Results with p<0.05 were considered statistically significant. Results: Our group consisted of 166 patients, 70 men and 96 women (42.2%/57.8%). Perioperative dural tear occurred in 23 patients (13.8%). Increased incidence of dural tear was at level L4/L5 (56.5%). Results showed a statistically significant increased incidence of iatrogenic durotomy in women compared to men (7.1%/18.7%; p=0.0404). Spondylolisthesis was considered as a statistically significant risk factor of an incidental dural tear (p=0.0125). We found a statistically significant relationship between the presence of type II diabetes mellitus (p=0.0397), osteoporosis (p=0.0166) and the presence of peroperative incidental durotomy. Conclusion: Our retrospective study showed a statistically significant increased incidence of incidental peroperative durotomy in females compared to males, in patients with spondylolisthesis, in patients with type II. diabetes mellitus and osteoporosis. Dural tear occurred most commonly at the level of L4 / L5.

Incidental durotomy during lumbar spine surgery: risk factors and anatomic locations

2013 ◽  
Vol 18 (2) ◽  
pp. 165-169 ◽  
Author(s):  
Yoshimasa Takahashi ◽  
Tetsuro Sato ◽  
Hironori Hyodo ◽  
Tomomaro Kawamata ◽  
Eiji Takahashi ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Spine Surgery ◽  
Spinal Canal ◽  
Degenerative Spondylolisthesis ◽  
Spinal Canal Stenosis ◽  
Lumbar Spine Surgery ◽  
Dural Tear ◽  
Canal Stenosis ◽  
Lumbar Spinal ◽  
Incidental Durotomy

Object Incidental durotomy (dural tear) is a common complication of lumbar spine surgery. The purpose of this study was to clarify the anatomical location of and the specific causative factors for incidental durotomy during primary lumbar spine surgery. Methods The authors retrospectively reviewed 1014 consecutive cases involving patients (412 women and 602 men; mean age 57 years; age range 11–97 years) who underwent a surgical procedure for treatment of degenerative lumbar spinal disease at their institution between 2002 and 2008. In total, 1261 disc levels were treated surgically. Disease at the treated levels included 544 disc herniations, 453 instances of spinal canal stenosis without spondylolisthesis, 188 instances of lumbar spinal canal stenosis with spondylolisthesis (degenerative spondylolisthesis), 49 instances of combined stenosis (stenosis with disc herniation), and 22 juxtafacet cysts. In 5 of the treated levels, the condition was classified as “other” disease. Treatment included fenestration with discectomy in 547 levels, fenestration alone in 626, fenestration with resection of juxtafacet cysts in 22, unilateral recapping laminoplasty in 20, posterolateral spinal fusion or posterior lumbar interbody fusion in 17, microscopic discectomy with tubular retractor in 14, and “other” in 15. Results Unintended durotomy occurred in 4% of cases and in 3.3% of disc levels. The incidence of dural tear was significantly higher in women (5.6%) than in men (3%). The incidence of dural tear was 2% in disc levels with lumbar disc herniation, 1.8% with lumbar spinal canal stenosis without spondylolisthesis, 9% with degenerative spondylolisthesis, and 18.2% with juxtafacet cysts; the incidence was significantly higher in levels with degenerative spondylolisthesis or levels with juxtafacet cysts, than in those with other diseases. Incidental durotomy occurred in 4 critical anatomical zones, namely, the caudal margin of the cranial lamina, cranial margin of the caudal lamina, herniated disc level, and medial aspect of the facet joint adjacent to the insertion of the hypertrophic ligamentum flavum. Conclusions Risk factors for unintended durotomy were female sex, older age, degenerative spondylolisthesis, and juxtafacet cysts. In this study, the authors identified 4 high-risk anatomical zones that spine surgeons should be aware of to avoid dural tears.

Ambulation on Postoperative Day #0 Is Associated With Decreased Morbidity and Adverse Events After Elective Lumbar Spine Surgery: Analysis From the Michigan Spine Surgery Improvement Collaborative (MSSIC)

Neurosurgery ◽  
2019 ◽  
Vol 87 (2) ◽  
pp. 320-328 ◽  
Author(s):  
Hesham Mostafa Zakaria ◽  
Michael Bazydlo ◽  
Lonni Schultz ◽  
Muwaffak Abdulhak ◽  
David R Nerenz ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Adverse Events ◽  
Spine Surgery ◽  
Postoperative Care ◽  
Enhanced Recovery ◽  
Cost Savings ◽  
Lumbar Spine Surgery ◽  
Lumbar Surgery ◽  
Single Level ◽  
Vein Thrombosis

Abstract BACKGROUND While consistently recommended, the significance of early ambulation after surgery has not been definitively studied. OBJECTIVE To identify the relationship between ambulation on the day of surgery (postoperative day (POD)#0) and 90-d adverse events after lumbar surgery. METHODS The Michigan Spine Surgery Improvement Collaborative (MSSIC) is a prospective multicenter registry of spine surgery patients. As part of routine postoperative care, patients either ambulated on POD#0 or did not. The 90-d adverse events of length of stay (LOS), urinary retention (UR), urinary tract infection (UTI), ileus, readmission, surgical site infection (SSI), pulmonary embolism/deep vein thrombosis (PE/DVT), and disposition to a rehab facility were measured. RESULTS A total of 23 295 lumbar surgery patients were analyzed. POD#0 ambulation was associated with decreased LOS (relative LOS 0.83, P &lt; .001), rehab discharge (odds ratio [OR] 0.52, P &lt; .001), 30-d (OR 0.85, P = .044) and 90-d (OR 0.86, P = .014) readmission, UR (OR 0.73, P = 10), UTI (OR 73, P = .001), and ileus (OR 0.52, P &lt; .001) for all patients. Significant improvements in LOS, rehab discharge, readmission, UR, UTI, and ileus were observed in subset analysis of single-level decompressions (4698 pts), multilevel decompressions (4079 pts), single-level fusions (4846 pts), and multilevel fusions (4413 pts). No change in rate of SSI or DVT/PE was observed for patients who ambulated POD#0. CONCLUSION POD#0 ambulation is associated with a significantly decreased risk for several key adverse events after lumbar spine surgery. Decreasing the incidence of these outcomes would be associated with significant cost savings. As ambulation POD#0 is a modifiable factor in any patient's postoperative care following most spine surgery, it should be encouraged and incorporated into spine-related, enhanced-recovery-after-surgery programs.

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