Article
Outcome and complications of patients with livercirrhosis child b & c after spinal instrumentation
Search Medline for
Authors
-
Ramazan Dalkilic
- Klinik für Neurochirurgie, Universitätsklinikum Jena
-
Christian Ewald
- Klinik für Neurochirurgie, Universitätsklinikum Jena
-
Rolf Kalff
- Klinik für Neurochirurgie, Universitätsklinikum Jena
| Published: | May 13, 2014 |
|---|
Outline
Text
Objective: With this study we want to share our experience regarding the outcome in patients with liver cirrhosis child b and c after spinal instrumentation. As known, the patients with cirrhosis (child b & c) are high risk patients due to their coagulation problems, higher infection risk as well as osteopenia.
Method: Between 2005-2012 we have operated 12 patients with liver cirrhosis (child b & c) and spinal fractures (spontaneous and traumatic). All these patients underwent an instrumented spinal surgery. This retrospective study is based on the patients disease, intra- and postoperative complications and the patient outcome score.
Results: The study group comprised 12 cirrhotic patients (9 males and 3 females). The average age was 59 years (±26). The average hospitalisation was 36 days (±27). 3 (25%) patients suffered from neurological deficits with hypaesthesia. 3 (75%) patients were noticed with pain at the thoracal-/lumbar spine. One patient was stabilised with wire cerclage due to dens fracture, 6 patients underwent dorsoventral instrumentation and in 5 patients we performed only posterior fusion due to thoracic and lumbar vertebral body fractures. 5 (41,6%) patients suffered from material dislocation postoperative. One of those patients had a postperative paraparesis and 4 (33,3%) of those had to be re-operated due to postoperative epidural hematoma. 4 of the patients had a wound infection (33,3%) and one of them experienced a sepsis. Pain reduction was achieved only in two patients. 6 patients needed more pain medication postoperative and one patient had paraparesis. One patient died postoperatively due to the desolate coagulation situation. The overall complicationrate was about 83,3%.
Conclusions: In our experience, in most of the patients we couldn’t achieve a better neurological or pain situation after spinal instrumentation. The risk of neurological deficits and postoperative infections are significantly higher in patients with cirrhosis. Carefull evaluation of these patients is needed before they are undergoing spine surgery with instrumentation.
