Here are seven studies to reduce spine surgery complications.
1. Bone morphogenic protein could cause male infertility, other complications. A study published in North American Spine Society's The Spine Journal shows a correlation between the use of rh-BMP-2 for spinal fusions and infertility among male patients. While the risk of infertility was shown in early studies, lead author Eugene J. Carragee, MD, suggests that the risk of infertility is much greater than was previously assumed and downplayed by industry-sponsored publications.
The study examined patients undergoing anterior lumbar interbody fusion using either rhBMP-2 or a local bone or iliac crest bone graft. Retrograd ejaculation events were recorded post-surgically. Approximated 7.2 percent of male patients undergoing one- or two-level ALIF with rhBMP-2 experienced RE, which causes infertility, while 0.6 percent of patients who underwent ALIF without rhBMP-2 experienced similar results. Patients undergoing single-level ALIF surgeries were less likely to experience RE in both cases. The use of rhBMP-2 has also been associated with early inflammatory reactions, including soft tissue swelling and sterile cyst formation, as well as early osteolysis and implant dislodgement.
2. Newer ceramic pin technology may be associated with a higher failure rate. Research published in the Journal of Spinal Disorders & Techniques suggests that the newer ceramic pin technology may not meet the expected minimum performance standards set by metallic material, which can cause complications and failures. Patient data from Harborview Medical Center in Seattle reviewed information from 307 patients, 44 of whom received ceramic pins. The remaining patients received metallic pins.
Of the patients with ceramic pins, 40.9 percent reported complications, compared with the 21.7 percent of patients who received metal pins. Aseptic loosening rates were 13.7 percent among the ceramic group and 8.3 percent among the metallic group. Pin site infections were 27.3 percent in the ceramic group and 13.3 percent in the metallic group. The study's authors suggested that the higher complication rates among patients with ceramic pins could derive from the changes made to the halo vest and pin design owning to the inherent mechanical property limitations of MRI-capable materials.
3. Long sacrum fusions associated with instrumentation-related complications. Long fusions to the sacrum are among the most common reasons for extending the instrumentation to the pelvis during complex spine surgery, thus increasing the risk of instrument-related complications. After a literature review, the authors of a study published in Spine recommended spine surgeons become familiar with all the potential risks and complications associated with different techniques and base patients' surgical treatment on their individual anatomy.
Poor sacrum bone quality, complex regional anatomy and biomechanical forces at the lumbosacral junction can contributed to the high rate of instrument-related problems. The authors also recommend advanced experience in performing these complex cases to reduce the risk of complications.
4. Cervical spine complications more frequent among trauma, oncologic procedures. A study recently published in The Journal of Spinal Disorders & Techniques found that the incidence of early complication in cervical spine procedures, especially among those for trauma and oncologic patients, are more common that previously suspected. The increase in complication rate most likely comes from the use of a broad definition for perioperative complications, elimination of recall bias through the use of prospective assessment and overall increased complexity in the cases, according to the report.
For the study, data was collected on 121 patients who underwent cervical spine surgery at Thomas Jefferson University Hospital in Philadelphia. A total of 47.1 percent of patients experienced early complications, and there were more minor complications (40.2 percent) than major complications (18.2 percent). The major complications were greatest in cases of infection (20 percent) and spinal oncologic procedures (30 percent).
5. Rigid occipitocervical construction may prevent complications. Lower short-term clinical complication rates are associated with rigid occipitocervical construction when compared with non-rigid occipitocervical fusion. Researchers examined data from 71 occipitocervical fusion patients, 46 of whom received rigid construction. The average follow-up among the patients was 6.3 months. At that time, there was a 48 percent complication rate associated with the non-rigidly fused patients, compared with a 10 percent complication rate among the rigidly fused. The data was reported in The Journal of Spinal Disorders & Techniques.
6. Dual rods can limit complications for early-onset scoliosis surgical correction. Surgeons can reduce the risk of complications associated with surgery for patients with early-onset scoliosis by delaying initial implantation of growth rods, using dual rods and limiting the number of lengthening procedures, according to the authors of a study published in The Journal of Bone & Joint Surgery. Data from 140 patients recorded in the Growing Spine Study Group database was used in this report. There were 58 patients who experienced at least one complication.
Of the patients with single-rod implants, 27 percent had unplanned procedures because of implant complications, compared with the 10 percent of the 69 patients who initially received dual rod implants. Of the patients with subcutaneous rod placement, 26 percent had wound complications. Approximately 10 percent of patients with submuscular rod placement experienced wound complications. Researchers found that the risk of complications during the treatment period decreased by 13 percent with each increased year of the patient's age at the initiation of treatment.
7. Pedicle screws may cause few complications than hooks for adolescent scoliosis surgery. A study of 247 patients who received surgery for adolescent scoliosis was conducted over a ten year period. Patients either received pedicle screws or hooks during their surgery. There were 22 complications related to the 896 pedicle screws implanted in patients, compared to the 60 complications related to the 867 hooks.
Loss of fixation and migration over time was reported in 14 pedicle screws. Acute loss of fixation was reported in 35 hooks and migration in 22 hooks. There were no implant-related neurologic or vascular injury complications. The results of this study were published in a Medscape Today report.
Related Articles on Spine Surgery:
Study Examines Percutaneous Pedicle Screw Placement Radiation
Study: Centroid Method Best for Measuring Scoliosis
Study: Endoscopic Assistance is Helpful for Microsurgery
Technology-related
1. Bone morphogenic protein could cause male infertility, other complications. A study published in North American Spine Society's The Spine Journal shows a correlation between the use of rh-BMP-2 for spinal fusions and infertility among male patients. While the risk of infertility was shown in early studies, lead author Eugene J. Carragee, MD, suggests that the risk of infertility is much greater than was previously assumed and downplayed by industry-sponsored publications.
The study examined patients undergoing anterior lumbar interbody fusion using either rhBMP-2 or a local bone or iliac crest bone graft. Retrograd ejaculation events were recorded post-surgically. Approximated 7.2 percent of male patients undergoing one- or two-level ALIF with rhBMP-2 experienced RE, which causes infertility, while 0.6 percent of patients who underwent ALIF without rhBMP-2 experienced similar results. Patients undergoing single-level ALIF surgeries were less likely to experience RE in both cases. The use of rhBMP-2 has also been associated with early inflammatory reactions, including soft tissue swelling and sterile cyst formation, as well as early osteolysis and implant dislodgement.
2. Newer ceramic pin technology may be associated with a higher failure rate. Research published in the Journal of Spinal Disorders & Techniques suggests that the newer ceramic pin technology may not meet the expected minimum performance standards set by metallic material, which can cause complications and failures. Patient data from Harborview Medical Center in Seattle reviewed information from 307 patients, 44 of whom received ceramic pins. The remaining patients received metallic pins.
Of the patients with ceramic pins, 40.9 percent reported complications, compared with the 21.7 percent of patients who received metal pins. Aseptic loosening rates were 13.7 percent among the ceramic group and 8.3 percent among the metallic group. Pin site infections were 27.3 percent in the ceramic group and 13.3 percent in the metallic group. The study's authors suggested that the higher complication rates among patients with ceramic pins could derive from the changes made to the halo vest and pin design owning to the inherent mechanical property limitations of MRI-capable materials.
3. Long sacrum fusions associated with instrumentation-related complications. Long fusions to the sacrum are among the most common reasons for extending the instrumentation to the pelvis during complex spine surgery, thus increasing the risk of instrument-related complications. After a literature review, the authors of a study published in Spine recommended spine surgeons become familiar with all the potential risks and complications associated with different techniques and base patients' surgical treatment on their individual anatomy.
Poor sacrum bone quality, complex regional anatomy and biomechanical forces at the lumbosacral junction can contributed to the high rate of instrument-related problems. The authors also recommend advanced experience in performing these complex cases to reduce the risk of complications.
Cervical spine
4. Cervical spine complications more frequent among trauma, oncologic procedures. A study recently published in The Journal of Spinal Disorders & Techniques found that the incidence of early complication in cervical spine procedures, especially among those for trauma and oncologic patients, are more common that previously suspected. The increase in complication rate most likely comes from the use of a broad definition for perioperative complications, elimination of recall bias through the use of prospective assessment and overall increased complexity in the cases, according to the report.
For the study, data was collected on 121 patients who underwent cervical spine surgery at Thomas Jefferson University Hospital in Philadelphia. A total of 47.1 percent of patients experienced early complications, and there were more minor complications (40.2 percent) than major complications (18.2 percent). The major complications were greatest in cases of infection (20 percent) and spinal oncologic procedures (30 percent).
5. Rigid occipitocervical construction may prevent complications. Lower short-term clinical complication rates are associated with rigid occipitocervical construction when compared with non-rigid occipitocervical fusion. Researchers examined data from 71 occipitocervical fusion patients, 46 of whom received rigid construction. The average follow-up among the patients was 6.3 months. At that time, there was a 48 percent complication rate associated with the non-rigidly fused patients, compared with a 10 percent complication rate among the rigidly fused. The data was reported in The Journal of Spinal Disorders & Techniques.
Scoliosis
6. Dual rods can limit complications for early-onset scoliosis surgical correction. Surgeons can reduce the risk of complications associated with surgery for patients with early-onset scoliosis by delaying initial implantation of growth rods, using dual rods and limiting the number of lengthening procedures, according to the authors of a study published in The Journal of Bone & Joint Surgery. Data from 140 patients recorded in the Growing Spine Study Group database was used in this report. There were 58 patients who experienced at least one complication.
Of the patients with single-rod implants, 27 percent had unplanned procedures because of implant complications, compared with the 10 percent of the 69 patients who initially received dual rod implants. Of the patients with subcutaneous rod placement, 26 percent had wound complications. Approximately 10 percent of patients with submuscular rod placement experienced wound complications. Researchers found that the risk of complications during the treatment period decreased by 13 percent with each increased year of the patient's age at the initiation of treatment.
7. Pedicle screws may cause few complications than hooks for adolescent scoliosis surgery. A study of 247 patients who received surgery for adolescent scoliosis was conducted over a ten year period. Patients either received pedicle screws or hooks during their surgery. There were 22 complications related to the 896 pedicle screws implanted in patients, compared to the 60 complications related to the 867 hooks.
Loss of fixation and migration over time was reported in 14 pedicle screws. Acute loss of fixation was reported in 35 hooks and migration in 22 hooks. There were no implant-related neurologic or vascular injury complications. The results of this study were published in a Medscape Today report.
Related Articles on Spine Surgery:
Study Examines Percutaneous Pedicle Screw Placement Radiation
Study: Centroid Method Best for Measuring Scoliosis
Study: Endoscopic Assistance is Helpful for Microsurgery