Prospective multicenter assessment of complication rates associated with adult cervical deformity surgery in 133 patients with minimum 1-year follow-up

2020 ◽  
Vol 33 (5) ◽  
pp. 588-600 ◽  
Author(s):  
Justin S. Smith ◽  
Thomas J. Buell ◽  
Christopher I. Shaffrey ◽  
Han Jo Kim ◽  
Eric Klineberg ◽  
...  
Keyword(s):  
Wound Infection ◽  
Japanese Orthopaedic Association ◽  
Neck Disability Index ◽  
Motor Deficit ◽  
Spine Deformity ◽  
Complication Rates ◽  
Deep Wound Infection ◽  
Deep Wound ◽  
Obstructive Sleep

OBJECTIVEAlthough surgical treatment can provide significant improvement of symptomatic adult cervical spine deformity (ACSD), few reports have focused on the associated complications. The objective of this study was to assess complication rates at a minimum 1-year follow-up based on a prospective multicenter series of ACSD patients treated surgically.METHODSA prospective multicenter database of consecutive operative ACSD patients was reviewed for perioperative (< 30 days), early (30–90 days), and delayed (> 90 days) complications with a minimum 1-year follow-up. Enrollment required at least 1 of the following: cervical kyphosis > 10°, cervical scoliosis > 10°, C2–7 sagittal vertical axis > 4 cm, or chin-brow vertical angle > 25°.RESULTSOf 167 patients, 133 (80%, mean age 62 years, 62% women) had a minimum 1-year follow-up (mean 1.8 years). The most common diagnoses were degenerative (45%) and iatrogenic (17%) kyphosis. Almost 40% of patients were active or past smokers, 17% had osteoporosis, and 84% had at least 1 comorbidity. The mean baseline Neck Disability Index and modified Japanese Orthopaedic Association scores were 47 and 13.6, respectively. Surgical approaches were anterior-only (18%), posterior-only (47%), and combined (35%). A total of 132 complications were reported (54 minor and 78 major), and 74 (56%) patients had at least 1 complication. The most common complications included dysphagia (11%), distal junctional kyphosis (9%), respiratory failure (6%), deep wound infection (6%), new nerve root motor deficit (5%), and new sensory deficit (5%). A total of 4 deaths occurred that were potentially related to surgery, 2 prior to 1-year follow-up (1 cardiopulmonary and 1 due to obstructive sleep apnea and narcotic use) and 2 beyond 1-year follow-up (both cardiopulmonary and associated with revision procedures). Twenty-six reoperations were performed in 23 (17%) patients, with the most common indications of deep wound infection (n = 8), DJK (n = 7), and neurological deficit (n = 6). Although anterior-only procedures had a trend toward lower overall (42%) and major (21%) complications, rates were not significantly different from posterior-only (57% and 33%, respectively) or combined (61% and 37%, respectively) approaches (p = 0.29 and p = 0.38, respectively).CONCLUSIONSThis report provides benchmark rates for ACSD surgery complications at a minimum 1-year (mean 1.8 years) follow-up. The marked health and functional impact of ACSD, the frail population it affects, and the high rates of surgical complications necessitate a careful risk-benefit assessment when contemplating surgery. Collectively, these findings provide benchmarks for complication rates and may prove useful for patient counseling and efforts to improve the safety of care.

scholarly journals Complication rates associated with 3-column osteotomy in 82 adult spinal deformity patients: retrospective review of a prospectively collected multicenter consecutive series with 2-year follow-up

2017 ◽  
Vol 27 (4) ◽  
pp. 444-457 ◽  
Author(s):  
Justin S. Smith ◽  
Christopher I. Shaffrey ◽  
Eric Klineberg ◽  
Virginie Lafage ◽  
Frank Schwab ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Wound Infection ◽  
Adult Spinal Deformity ◽  
Complication Rates ◽  
Dural Tear ◽  
Deep Wound Infection ◽  
Deep Wound ◽  
Rod Breakage ◽  
Delayed Complications

OBJECTIVEAlthough 3-column osteotomy (3CO) can provide powerful alignment correction in adult spinal deformity (ASD), these procedures are complex and associated with high complication rates. The authors' objective was to assess complications associated with ASD surgery that included 3CO based on a prospectively collected multicenter database.METHODSThis study is a retrospective review of a prospectively collected multicenter consecutive case registry. ASD patients treated with 3CO and eligible for 2-year follow-up were identified from a prospectively collected multicenter ASD database. Early (≤ 6 weeks after surgery) and delayed (> 6 weeks after surgery) complications were collected using standardized forms and on-site coordinators.RESULTSOf 106 ASD patients treated with 3CO, 82 (77%; 68 treated with pedicle subtraction osteotomy [PSO] and 14 treated with vertebral column resection [VCR]) had 2-year follow-up (76% women, mean age 60.7 years, previous spine fusion in 80%). The mean number of posterior fusion levels was 12.9, and 17% also had an anterior fusion. A total of 76 early (44 minor, 32 major) and 66 delayed (13 minor, 53 major) complications were reported, with 41 patients (50.0%) and 45 patients (54.9%) affected, respectively. Overall, 64 patients (78.0%) had at least 1 complication, and 50 (61.0%) had at least 1 major complication. The most common complications were rod breakage (31.7%), dural tear (20.7%), radiculopathy (9.8%), motor deficit (9.8%), proximal junctional kyphosis (PJK, 9.8%), pleural effusion (8.5%), and deep wound infection (7.3%). Compared with patients who did not experience early or delayed complications, those who had these complications did not differ significantly with regard to age, sex, body mass index, Charlson Comorbidity Index, American Society of Anesthesiologists score, smoking status, history of previous spine surgery or spine fusion, or whether the 3CO performed was a PSO or VCR (p ≥ 0.06). Twenty-seven (33%) patients had 1–11 reoperations (total of 44 reoperations). The most common indications for reoperation were rod breakage (n = 14), deep wound infection (n = 15), and PJK (n = 6). The 24 patients who did not achieve 2-year follow-up had a mean of 0.85 years of follow-up, and the types of early and delayed complications encountered in these 24 patients were comparable to those encountered in the patients that achieved 2-year follow-up.CONCLUSIONSAmong 82 ASD patients treated with 3CO, 64 (78.0%) had at least 1 early or delayed complication (57 minor, 85 major). The most common complications were instrumentation failure, dural tear, new neurological deficit, PJK, pleural effusion, and deep wound infection. None of the assessed demographic or surgical parameters were significantly associated with the occurrence of complications. These data may prove useful for surgical planning, patient counseling, and efforts to improve the safety and cost-effectiveness of these procedures.

scholarly journals AN APPROACH FOR MEDIASTINITIS PREVENTIONIN PATIENTS FOLLOWING CARDIAC SURGERY

2015 ◽  
Vol 7 (4) ◽  
pp. 38-42 ◽  
Author(s):  
A V Sotnikov ◽  
V M Melnikov ◽  
R V Almadi ◽  
G N Gorbunov
Keyword(s):  
Cardiac Surgery ◽  
Wound Infection ◽  
Incidence Rate ◽  
Control Group ◽  
Study Group ◽  
Intravenous Injections ◽  
Deep Wound Infection ◽  
Period 2 ◽  
Deep Wound

The aim of this study was to reduce incidence of sternal deep wound infection (DWI) in patients following cardiac surgery. An experience of cardiac surgery by sternotomy access in 429 consecutive patients was presented. Perioperative intravenous injections of cefazolin were used in 225 patients (control group). Combination of perioperative intravenous injections with local retrosternal irrigation of cefazolin before sternum closure was used in 204 patients (study group). In control group sternal DWI occurred in 10 patients (4.4%), and in 4 patients a resternotomy sanation required. There were no deaths in this group due to infection or sepsis. In follow-up period (3 years), instability of sternum occurred in 3 patients (1.3%), and in 1 (0.4%) sternum reosteosynthesis required. In studied group the sternal DWI did not occur (p<0.01). Sternum instability and/or indications for sternum reosteosynthesis were not determined in follow-up period (2 years). It was concluded, that combination of intravenous and local usage of cefazolin in cardiac surgery patients is a simple and effective approach to prevent sternal DWI. Application of this method significantly (p<0.01) reduces the incidence rate of mediastinitis.

scholarly journals Treatment of Catastrophic Failures of Achilles Tendon Repairs Due to Deep Wound Complications

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
Jamal Ahmad
Keyword(s):  
Surgical Treatment ◽  
Achilles Tendon ◽  
Wound Infection ◽  
Clinical Outcomes ◽  
Single Stage ◽  
Wound Complications ◽  
Deep Wound Infection ◽  
Deep Wound ◽  
Catastrophic Failures

Category: Sports Introduction/Purpose: The Achilles tendon is the most commonly injured tendon in the lower extremity. Whether these ruptures are acute or chronic, a surgical Achilles repair or reconstruction is often needed to restore tendon integrity and function. Risks from such surgeries include superficial or deep wound infections and/or dehiscence. To date, there is scant literature regarding the treatment of catastrophic failures of Achilles tendon repairs or reconstructions from deep wound infection and dehiscence. The purpose of this study is to retrospectively examine clinical outcomes from uniform single-stage surgical treatment of catastrophic failures of Achilles tendon repairs or reconstructions from deep wound complications. Methods: Between 2007 and 2016, 10 patients developed a deep wound infection and dehiscence after surgical treatment of an acute or chronic Achilles rupture. Medical co-morbidities included obesity in 4, diabetes in 3, and nicotine use in 2 patients. Six and 4 patients had a mid-substance and insertional Achilles rupture respectively. Three patients had an acute injury that received an end-to-end suture repair. Seven patients had a chronic injury with Achilles retraction, which necessitated proximal Achilles or gastrocnemius lengthening. These patients required surgery for their wound problem due to depth and involvement of their Achilles repair/reconstruction site. Surgery involved a single-stage wound irrigation and debridement, Achilles excisional debridement at the repair/reconstruction site, flexor hallucis longus transfer to the calcaneus to replace the compromised or failed Achilles repair/reconstruction, and primary or vacuum assisted wound closure. Patients were followed for 6 months after this surgery and invited for recent follow-up to collect data. Results: With uniform surgical treatment, full resolution of deep wound infection and dehiscence after Achilles repair/reconstruction was achieved in all 10 patients. No patients developed a recurrence of wound complications and/or infection to necessitate any further surgical debridements. All 10 patients presented for recent follow-up at a mean of 57.3 months. Mean Foot and Ankle Ability Measures increased from 36.3% at initial presentation before Achilles repair/reconstructive surgery to 84.2% at latest follow-up (P<0.05). Mean Visual Analog Scores of pain decreased from 6.6 of 10 before the Achilles repair/reconstruction to 1.5 of 10 at latest follow-up (P<0.05). All patients were able to return to normal gait and full activities at home, with 3 reporting difficulties with prolonged ankle activities at work. Conclusion: This study demonstrates that our method of single-stage surgical treatment of catastrophic failures of Achilles tendon repairs or reconstructions from deep wound complications can achieve a high rate of improved patient function and pain relief. Clinical outcomes of treating patients with this particular complication of Achilles repair/reconstruction in this manner have not been previously reported in the orthopaedic literature. As catastrophic failures of Achilles tendon repairs or reconstructions from deep wound complications are studied further, our method of surgical care should be strongly considered as treatment.

scholarly journals Outcomes of Subacromial Balloon Spacer Implantation for Massive and Irreparable Rotator Cuff Tears: A Systematic Review

2019 ◽  
Vol 7 (10) ◽  
pp. 232596711987571 ◽  
Author(s):  
Russell K. Stewart ◽  
Lisa Kaplin ◽  
Stephen A. Parada ◽  
Benjamin R. Graves ◽  
Nikhil N. Verma ◽  
...  
Keyword(s):  
Systematic Review ◽  
Patient Satisfaction ◽  
Rotator Cuff ◽  
Wound Infection ◽  
Constant Score ◽  
Rotator Cuff Tears ◽  
Deep Wound Infection ◽  
Deep Wound ◽  
Shoulder Score

Background:Selection of optimal treatment for massive to irreparable rotator cuff tears (RCTs) entails a challenging decision-making process in which surgeons must consider several factors, including duration of symptoms, tear pattern, tear size, and muscle quality, as well as patient characteristics such as age, comorbidities, shoulder dominance, and activity level. Unfortunately, no clear consensus has been reached regarding optimal management.Purpose:To systematically review the published literature assessing outcomes after subacromial balloon spacer implantation for treatment of massive and irreparable RCTs.Study Design:Systematic review; Level of evidence, 4.Methods:A comprehensive literature search was performed in September 2018 through use of MEDLINE and the Cochrane Library electronic databases. Studies were assessed for multiple outcomes of interest including Constant score, Oxford Shoulder Score (OSS), University of California Los Angeles (UCLA) Shoulder Score, complications, and patient satisfaction.Results:After applying the selection criteria, 12 clinical studies were included for data extraction and analysis. In total, 291 shoulders (in 284 patients) treated with subacromial balloon spacer implantation were pooled for evaluation, with a mean follow-up of 22.9 ± 14.9 months (range, 6-60 months). Constant scores were used as an outcome metric for 267 shoulders (91.7%; 11 studies), with improvements in mean Constant score ranging from 18.5 to 49.6 points. Patient satisfaction was assessed in 105 patients (37.0%; 5 studies), with rates of patients indicating they were satisfied or very satisfied with their treatment outcome ranging from 45.8% to 100%. A total of 6 patients (2.1%) experienced complications related to balloon spacer implantation, including transient neurapraxia of the lateral antebrachial cutaneous nerve, superficial wound infection, deep wound infection, and balloon migration. Of these, 3 patients (2 balloon migration, 1 deep wound infection) required subsequent surgeries for balloon removal.Conclusion:Placement of the subacromial balloon spacer is a minimally invasive, technically simple procedure with favorable patient-reported outcomes at limited short-term follow-up. However, inherent methodological limitations and patient heterogeneity between studies may impair our ability to fully characterize the longer term efficacy, particularly relative to other potential surgical options. Further prospective randomized or comparative studies are warranted to ascertain clinical outcomes of subacromial balloon spacer in the management of massive and irreparable RCTs.

scholarly journals Long-term clinical outcomes following 3- and 4-level anterior cervical discectomy and fusion

2016 ◽  
Vol 24 (6) ◽  
pp. 885-891 ◽  
Author(s):  
Rafael De la Garza-Ramos ◽  
Risheng Xu ◽  
Seba Ramhmdani ◽  
Thomas Kosztowski ◽  
Mohamad Bydon ◽  
...  
Keyword(s):  
Neck Pain ◽  
Wound Infection ◽  
Clinical Outcomes ◽  
Anterior Cervical Discectomy ◽  
Complication Rates ◽  
Cervical Discectomy ◽  
Deep Wound Infection ◽  
Deep Wound ◽  
Level Group

OBJECTIVE The purpose of this study was to report the long-term clinical outcomes following 3- and 4-level anterior cervical discectomy and fusion (ACDF). METHODS A retrospective review of all adult neurosurgical patients undergoing elective ACDF for degenerative disease at a single institution between 1996 and 2013 was performed. Patients who underwent first-time 3- or 4-level ACDF were included; patients with previous cervical spine surgery, those undergoing anterior/posterior approaches, and those with corpectomy were excluded. Outcome measures included perioperative complication rates, fusion rates, need for revision surgery, Nurick Scores, Odom's criteria, symptom resolution, neck visual analog scale (VAS) pain score, and persistent narcotics usage. RESULTS Seventy-one patients who underwent 3-level ACDF and 26 patients who underwent 4-level ACDF were identified and followed for an average of 7.6 ± 4.2 years. There was 1 case (3.9%) of deep wound infection in the 4-level group and 1 case in the 3-level group (1.4%; p = 0.454). Postoperatively, 31% of patients in the 4-level group complained of dysphagia, compared with 12.7% in the 3-level group (p = 0.038). The fusion rate was 84.6% after 4-level ACDF and 94.4% after 3-level ACDF (p = 0.122). At last follow-up, a significantly higher proportion of patients in the 4-level group continued to have axial neck pain (53.8%) than in the 3-level group (31%; p = 0.039); the daily oral morphine equivalent dose was significantly higher in the 4-level group (143 ± 97 mg/day) than in the 3-level group (25 ± 10 mg/day; p = 0.030). Outcomes based on Odom's criteria were also different between cohorts (p = 0.044), with a significantly lower proportion of patients in the 4-level ACDF group experiencing an excellent/good outcome. CONCLUSIONS In this study, patients who underwent 4-level ACDF had significantly higher rates of dysphagia, postoperative neck pain, and postoperative narcotic usage when compared with patients who underwent 3-level ACDF. Pseudarthrosis and deep wound infection rates were also higher in the 4-level group, although this did not reach statistical significance. Additionally, a smaller proportion of patients achieved a good/excellent outcome in the 4-level group than in the 3-level group. These findings suggest a significant increase of perioperative morbidity and worsened outcomes for patients who undergo 4- versus 3-level ACDF.

scholarly journals The Midterm Surgical Outcome of Modified Expansive Open-Door Laminoplasty

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Kuang-Ting Yeh ◽  
Ru-Ping Lee ◽  
Ing-Ho Chen ◽  
Tzai-Chiu Yu ◽  
Cheng-Huan Peng ◽  
...  
Keyword(s):  
Neck Pain ◽  
Facet Joint ◽  
Japanese Orthopaedic Association ◽  
Neck Disability Index ◽  
Standard Technique ◽  
Invasive Technique ◽  
Open Door ◽  
Gradual Improvement ◽  
Less Invasive

Laminoplasty is a standard technique for treating patients with multilevel cervical spondylotic myelopathy. Modified expansive open-door laminoplasty (MEOLP) preserves the unilateral paraspinal musculature and nuchal ligament and prevents facet joint violation. The purpose of this study was to elucidate the midterm surgical outcomes of this less invasive technique. We retrospectively recruited 65 consecutive patients who underwent MEOLP at our institution in 2011 with at least 4 years of follow-up. Clinical conditions were evaluated by examining neck disability index, Japanese Orthopaedic Association (JOA), Nurick scale, and axial neck pain visual analog scale scores. Sagittal alignment of the cervical spine was assessed using serial lateral static and dynamic radiographs. Clinical and radiographic outcomes revealed significant recovery at the first postoperative year and still exhibited gradual improvement 1–4 years after surgery. The mean JOA recovery rate was 82.3% and 85% range of motion was observed at the final follow-up. None of the patients experienced aggravated or severe neck pain 1 year after surgery or showed complications of temporary C5 nerve palsy and lamina reclosure by the final follow-up. As a less invasive method for reducing surgical dissection by using various modifications, MEOLP yielded satisfactory midterm outcomes.

Offset layered closure reduces deep wound infection in early-onset scoliosis surgery

2016 ◽  
Vol 25 (4) ◽  
pp. 361-368 ◽  
Author(s):  
Alexandra M. Grzywna ◽  
Patricia E. Miller ◽  
Michael P. Glotzbecker ◽  
John B. Emans
Keyword(s):  
Wound Infection ◽  
Early Onset ◽  
Early Onset Scoliosis ◽  
Scoliosis Surgery ◽  
Deep Wound Infection ◽  
Deep Wound

scholarly journals Effective Protocol to Treat Patients with Deep Wound Infection after Spinal Lumbar Fusion

2015 ◽  
Vol 5 (1_suppl) ◽  
pp. s-0035-1554547-s-0035-1554547
Author(s):  
Asdrubal Falavigna ◽  
Orlando Righesso ◽  
Alisson Roberto Teles ◽  
Pedro Guarise da Silva ◽  
Francisco Bassanesi
Keyword(s):  
Wound Infection ◽  
Lumbar Fusion ◽  
Deep Wound Infection ◽  
Deep Wound

scholarly journals Outcomes observed during a 1-year clinical and radiographic follow-up of patients treated for 1- or 2-level cervical degenerative disease using a biodegradable anterior cervical plate

2016 ◽  
Vol 25 (2) ◽  
pp. 205-212 ◽  
Author(s):  
Mengcun Chen ◽  
Shuhua Yang ◽  
Cao Yang ◽  
Weihua Xu ◽  
Shunan Ye ◽  
...  
Keyword(s):  
Japanese Orthopaedic Association ◽  
Fusion Rate ◽  
Complication Rates ◽  
Disc Disease ◽  
Clinical Issue ◽  
Radiographic Outcomes ◽  
Cobb’S Angle ◽  
Cervical Plate ◽  
Anterior Cervical Plate

OBJECTIVE The purpose of this study was to present an initial surgical experience in the management of 1- or 2-level degenerative disc disease of the cervical spine using biodegradable anterior cervical plates (bACPs) in anterior cervical discectomy and fusion (ACDF). The authors also aimed to provide insight into this critical and controversial clinical issue by clarifying outcomes for patients receiving bACPs and by comparing their outcomes with those achieved using a traditional metallic anterior cervical plate (mACP) implant. METHODS A retrospective review was conducted for 2 series of patients who had undergone ACDF using either bACP (31 patients, 38 segments) or mACP (47 patients, 57 segments) instrumentation. The patients were followed up for a mean 13.5 ± 0.9 months (range 12–18 months) in the bACP group and 14.8 ± 1.5 months (range 14–22 months) in the mACP group. Clinical outcomes were determined according to scores on the visual analog scale (VAS), the modified Japanese Orthopaedic Association (mJOA) scoring system, and Odom's criteria. Radiological images were used to assess fusion rates, intervertebral height, Cobb's angle, and the width of prevertebral soft tissue. RESULTS Both VAS and mJOA scores were significantly improved at each follow-up in both groups. Excellent or good results according to Odom's criteria were achieved in 93.5% (29/31) of patients in the bACP group and 93.6% (44/47) of patients in the mACP group. At 6 months postoperatively, the fusion rate was 94.7% (36/38) in the bACP group and 96.5% (55/57) in the mACP group, but subsidence of the intervertebral space at the surgical level was more evident in the bACP group. Angulation, as measured by Cobb's angle, demonstrated obvious healing in both groups, while better maintenance was observed in the mACP group. The local inflammatory reaction was uneventful during follow-up. Dysphonia and dysphagia were observed in both groups during the follow-up. CONCLUSIONS The relatively comparable early clinical and radiographic outcomes and the overall acceptable complication rates for bACP and mACP use suggest that bACPs could be used as alternative instruments in ACDF. Mild graft resorption was noted without evidence of symptoms. However, the prospective efficacy of biodegradable instrumentation can only be elucidated with longer-term observation.

Sign in / Sign up

Export Citation Format

Share Document