Artikel
Does prior spinal surgery increase the surgical complication rate for PLIF procedures at the index segment?
Erhöht eine vorausgegangene Operation die chirurgischen Komplikationen bei PLIF-Operationen im Index-Segment?
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Autoren
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Andreea Maria Sandica
- Hannover Medical School, Clinic for Neurosurgery, Hannover, Deutschland
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Joachim Kurt Krauss
- Hannover Medical School, Clinic for Neurosurgery, Hannover, Deutschland
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Shadi Al-Afif
- Hannover Medical School, Clinic for Neurosurgery, Hannover, Deutschland
| Veröffentlicht: | 4. Juni 2021 |
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Gliederung
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Objective: Posterior lumbar interbody fusion (PLIF) surgery is used widely in the treatment of various degenerative pathologies of the lumbar spine. Its combination with dorsal pedicle screw fixation increases the construct rigidity and provides earlier stability. However, PLIF surgery necessitates mobilization of the dural sac to introduce the cage into the intervertebral space. The approach to a segment which was operated before (disc surgery or laminectomy) is usually more demanding because of scar tissue and the adherent dura, which makes the insertion of the PLIFS more risky. Here we examined whether a prior surgery increases the risk for intraoperative complications during PLIF surgery.
Methods: Over a time period of 8 years, 213 patients underwent PLIF surgery of the lumbar spine in our department. Group A consisted of 82 patients who had prior surgery (33 had a discectomy and 61 had a dorsal spinal canal decompression), while the 131 patients in group B had no prior surgery at the index segment. The clinical and operative data were collected from the patients´ record and the occurrence of operative complications was compared between both groups.
Results: There were 96 men and 117 women. The median age in group A and B was 53 vs. 54, respectively. The median surgery time was longer in group A than B (277 vs. 260 minutes , p = 0,026). In group A, the incidence of postoperative epidural hematomas (5 vs. 1, p = 0,022) and immediate neurological deficits (8 vs. 0, p = 0,001) was significantly higher. At discharge, deficits were improved in six out of eight patients. Dural tears (11 vs. 8, p = 0,068) tended to occur also more frequently in group A. There was no significant difference regarding the time of hospital stay between both groups (median values: 8 vs.7 days, p = 0,240).
Conclusion: Although the risk for dural tears and postoperative neurological deficits is higher in patients with prior surgery, our results suggest that PLIF surgery is also safe in this group of patients. Meticulous preparation of the dural sac and the spinal nerve roots may avoid dural or neural injury.
