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72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

06.06. - 09.06.2021

Complications and outcome of patients with liver cirrhosis Child stages B&C after spinal instrumentation

Komplikationen und Outcome bei Patienten mit Leberzirrhose Stadium Child B&C nach instrumentierten Wirbelsäuleneingriffen

Meeting Abstract

Suche in Medline nach

  • presenting/speaker Ramazan Dalkilic - Universitätsklinikum Jena, Klinik und Poliklinik für Neurochirurgie, Jena, Deutschland
  • Rolf Kalff - Universitätsklinikum Jena, Klinik und Poliklinik für Neurochirurgie, Jena, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie. sine loco [digital], 06.-09.06.2021. Düsseldorf: German Medical Science GMS Publishing House; 2021. DocP102

doi: 10.3205/21dgnc391, urn:nbn:de:0183-21dgnc3914

Veröffentlicht: 4. Juni 2021

© 2021 Dalkilic et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objective: With this study we want to share our experience and outcome with patients with liver cirrhosis Child-Pugh stages B and C after instrumented spine surgery. We already know that patients with cirrhosis (Child-Pugh B & C) are high-risk patients due to their coagulation problems, higher infection risk, as well as osteopenia.

Methods: Between 2012 and 2020 we have operated on 14 patients with liver cirrhosis (Child-Pugh B & C) and spinal fractures (spontaneous and traumatic). All these patient underwent instrumented spinal surgery. This retrospective study is based on the patients’ conditions, intra- and postoperative complications, and the patient outcome scores.

Results: The study group comprised 14 cirrhotic patients (11 males and 3 females). The average age was 59 years (±26). The average length of stay was 36 days (±27). 4 (29%) patients were admitted with neurological deficits with hypoaesthesia, 10 (77%) patients were admitted with thoracolumbar pain. One patient was stabilised with wire cerclage due to dens fracture, 5 patients underwent dorsoventral instrumentation, and in 5 patients we performed only posterior fusion due to thoracic and lumbar vertebral body fractures. 1 patient received an ACDF with plating. 5 (35.5%) patients experienced postoperative material dislocation. One of these patient suffered postoperative paraparesis and also 5 (35.5%) of this group had to be re-operated on due to postoperative epidural bleeding. 4 of the patients had postoperative wound infections (28.6%) and one of them became septic (7.1%). Postoperative pain reduction was achieved in only three patients (21.4%). 7 (50.0) of the cohort required up-titration of their pain medication postoperatively and one patient had permanent paraparesis. One (7.1%) patient died postoperatively due to drastically deranged coagulation. The overall complication rate was about 78.6%.

Conclusion: In our experience, in most of patients with liver cirrhosis (Child-Pugh stages B & C) we were unable to improve the neurological or pain situation with spinal instrumentation. The risk of neurological complications and infections are markedly higher in patients with cirrhosis. These patients require in-depth and individualised evaluation before undergoing spine surgery with instrumentation.