Artikel
Challenges of cervical spine injuries due to trauma – an analysis of spinal surgery complications
Herausforderung Halswirbelsäulenverletzung mit Querschnittlähmung – Analyse wirbelsäulenchirurgischer Komplikationen
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Veröffentlicht: | 8. Mai 2019 |
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Gliederung
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Objective: Traumatic cervical spine cord injury poses are a major challenge to the spinal centers due to surgical severity and emergency care. The few references available indicate a high operative and treatment-related complication rate. Particularly in the cervical area complication rate is up to 40% [1].
The aim of this study is to analyze the influence of surgical complications (SC) on the outcome, the length of hospital stay and costs.
Methods: From 2011 to 2017 a single-center case-control study was analyzed in our hospital for parameters of patients with acute traumatic tetraplegia and spinal surgery (Ethics vote EA2/015/15). The cases with defined criteria for an SC (Table 1 [Tab. 1]) were compared with the total patients with spinal cord injuries on treatment duration, treatment-related complications and costs in adjusted statistical models.
Results: Parameters of 146 patients were analyzed. SC occurred in 21% of cases (Table 1 [Tab. 1]). The group comparison showed significantly more SCs in a spine injury with a motor complete paralysis (ASIA Impairment Scale A and B) (p=0.039). Outcome analysis showed a significantly higher incidence of dysphagia for the group with SC (Table 2 [Tab. 2]). The mortality rate in the first hospital stay was significantly higher in the group with SC than in the group without SC (Table 2 [Tab. 2]). The treatment times were significantly higher in the group with SC 85–210 days (MW 118 days) (p<0.005) than without SC 51–137 days (MW 77 days). The treatment times in intensive care units and the ventilation times were similar. SCs led to a significant increase in surgery and overall costs (Table 2 [Tab. 2]).
Conclusion: The rehabilitation of patients with traumatic spinal cord injury starts with the surgery. SCs in primary hospital stay are associated with a higher mortality rate and a significant reduction in quality of life due to dysphagia. Additionally the medical as well as the economic outcome worsens. For these reasons, in spite of the emergency situation and the severity of the injury, high-quality initial treatment of the spinal injury and consistent complication management have to be carried out by specialised centers for cervical spinal injuries.
References
- 1.
- Wilson JR, et al. Clinical prediction model for acute inpatient complications after traumatic cervical spinal cord injury: a subanalysis from the Surgical Timing in Acute Spinal Cord Injury Study. J Neurosurg. 2012;17:46-51.