Assessing the outcomes after Spinal Fusion surgery.

From: Perioperative Morbidity and Mortality After Anterior, Posterior, and Anterior/Posterior Spine Fusion Surgery. Stavros G. Memtsoudis, MD, PhD; Vassilios I. Vougioukas, MD, PhD; Yan Ma, PhD; Licia K. Gaber-Baylis, BA; Federico P. Girardi, MD. Spine. 2011;36(22):1867-1877. © 2011 Lippincott Williams & Wilkins.

The utilization of Spinal fusion techniques have increased dramatically despite the relatively few studies showing the safety of this procedure. There is also a relative lack of studies comparing the relative spinal surgical techniques and the outcomes associated with them.

This study was designed to assess the Morbidity (the rate of incidence) and Mortality (the measure of the number of deaths) and to determine the independent risk factors for in-hospital death. associated with the various surgical approaches to spinal fusion surgery.

The outcomes being measured were: Perioperative (after operation) of Anterior Spinal Fusion (ASF), Posterior Spinal Fusion (PSF) and APSF (Anterior Posterior Spinal Fusion). 

Here are some X-rays, post-operative:

Results of the study:

There was an increased incidence of perioperative complications and adjusted risk of in-hospital mortality among hospital admissions undergoing APSF and ASF when compared to PSF procedures.

The highest rates of fatal outcomes and complications were associated with procedures using the anterior thoracic approach.

Risk factors for in-hospital mortality included the following: male gender, advanced age, procedures indicated for metastatic disease and trauma, as well as the presence of several comorbidities and perioperative complications. 

Procedures involving the anterior spine were associated with higher morbidity and mortality in our study, despite being performed in younger individuals with lower comorbidity burden.

The highest rate of morbidity and mortality was seen in APSF patients, which can be explained by longer surgical times, more blood loss, and increased surgical complexity. 

When studying patient demographics and their association with mortality, we found increased independent risk of a fatal event after spine fusion among men.

We identified an increased incidence of morbidity and risk for mortality in patients with advanced age. Patients over the age of 75 years made up almost one- third of all mortalities, despite representing less than 9% of the spine surgical population in this study.

Pulmonary circulatory disease, congestive heart failure, renal disease, and coagulopathies were associated with the highest increases of risk for perioperative mortality.

Perioperative complications were also associated with increases in the odds of a fatal event. Pulmonary embolism, perioperative shock, ARDS, and cardiac complications were associated with the highest risk of mortality. All of these events had the highest incidence among APSF patients.

It was determined that APSF and ASF carried an increased adjusted risk of in-hospital mortality and greater incidence of in-hospital complications when compared to PSF procedures.

What can we learn from this study ? Like the old saying goes "an ounce of prevention equals a pound of cure". Aside from unforeseen circumstances such as trauma, there are ways we can help prevent our spines from getting to this level of degeneration.

1.) Have a spinal exam and check up.

2.) Don't ignore early signs such as: recurring back pain that may self-resolve or resolve with medications. In my experience, most cases of spinal degeneration and herniated discs have manifested themselves in the past and have not been adequately or properly treated. Chiropractic therapy is a drugless, non-surgical, intervention which can help with many types of back pain.

3.) For those of you who have already reached the advanced stages of spinal arthritis, osteroarthritis, degenerative disc disease, sciatica or have one or multiple herniated discs, VAX-D spinal decompression therapy is an alternative approach to some types of surgery and "endless" epidural injections.

4.) Exercise, lose weight and keep a healthy lifestyle.

Dr. Rommel Hindocha is a Chiropractor in San Mateo California. In addition to Chiropractic therapy, he does perform non-surgical Spinal Decompression therapy at 101 S. San Mateo Drive, Suite 200, San Mateo, CA  94401. You can reach Peninsula Spine & Sports Rehabilitation at (650) 347-2225.

Dr. Rommel Hindocha, D.C. QME Dr. Rommel Hindocha, QME, is a licensed chiropractor and provides spine health and sports rehabilitation treatments to patients in the greater Burlingame, California, area. Dedicated to helping patients live pain-free lives, Dr. Hindocha continues to research and employ the latest proven treatment options for chronic and acute pain and is certified by the National Board of Chiropractic Examiners.

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