On the issue of predictors of complications of surgical treatment of patients with spinal cord injury in the lower thoracic and lumbar spine

Abstract

Objective. To determine the predictors of complications of surgical treatment of patients with spinal cord injury (SCI) in the lower thoracic and lumbar spine using various options for performing decompression and stabilization surgeries.Material and Methods. A total of 240 patients with spinal cord injury in the lower thoracic and lumbar spine were operated on in 2010–2021. All patients were divided into 3 groups depending on the tactical option of surgical treatment performed. In Group 1, patients (n =  129) underwent two-stage surgical intervention through combined approach: the first stage included transpedicular fixation (TPF) supplemented with posterior decompression options and the second stage – fusion through anterior approach, in Group 2 (n = 36) – TPF and decompression through posterior approach, and in Group 3 (n = 75) – one-stage surgical intervention including TPF, decompression and fusion through extended posterior approach. An analysis of surgical complications was carried out, and factors that increase the likelihood of their development were identified. Comparison of groups according to quantitative indicators was carried out using single-factor analysis of variance (with normal distribution), and Kruskal-Wallis test (with distribution other than normal). Comparison of percentages in the analysis of multifield contingency tables was performed using Pearson’s χ2 test.Results. A total of 130 cases of postoperative complications were identified that corresponded to the grade 2 or 3 of the Clavien – Dindo classification, including respiratory, infectious processes in the surgical site, iatrogenic neurological complications, intraoperative damage to the dura mater, and instability of metal fixation. In two-stage surgery through combined approaches, the most common were respiratory complications (17.1 %), intraoperative damage to the dura mater (9.3 %) and surgical site infection (7.0 %). Predictors of these complications included the severity of preoperative neurological deficit of ASIA grade A or B, the patient’s preoperative condition corresponding to the average risk of death according to the modified SOFA score, and the performance of extended laminectomy. In isolated TPF with reposition and stabilization without fusion, the most common complication was instability of metal fixation in the long-term period (47.1 %), the predictors of which were incomplete reposition of the fractured vertebral body and performing two-segment TPF. In one-stage decompression and stabilization interventions with TPF and fusion through the extended posterior approach, the most common complications were intraoperative damage to the dura mater (26.7 %), respiratory complications (18.7 %), infectious processes in the surgical site (10.7 %), iatrogenic neurological complications (12.0 %), and instability of metal fixation (16.1 %). Predictors of these complications were the severity of the patient’s condition before surgery, corresponding to the average risk of death according to the modified SOFA score, neurological deficit of type D or rapidly regressing neurological deficit of type C, A or B according to ASIA scale, and bisegmental fusion when the injury was located at the lumbar level.Conclusion. Analysis of the causes of complication development contributes to their prevention, and can also form the basis for algorithms to choose tactics and technology for performing decompression and stabilization operations.