Complications of Posterior Fusion and Instrumentation for Degenerative Lumbar Scoliosis
Methods: 47 patients (average age 66.6, range 48 to 83) of degenerative lumbar scoliosis undergoing posterior instrumentation with a minimum 2-yr follow-up were analyzed. The average levels of fusion was 4.7±2.2 segments. The upper instrumented vertebra was T10 in 10 patients, L1 in 6 patients, and L2 in 15 patients. The lower instrumented vertebra was L5 in 22 patients, and sacrum in 24 patients. 7 patients had additional PLIF at the lower lumbar spine. We evaluated the early perioperative (<3 mo after surgery) and late complications.
Results: The complications were more likely in older patients (>65 years) than younger patients (P=0.05). 28 patients had major co-morbidities including hypertension, diabetes and heart disease. The two or more co-morbidities had the tendency to increase early complications with no statistical significance (P>0.05). Mean EBL was 2106±1083ml. More than 2000ml of blood loss increased early complications with a statistical difference (P=0.01). Operative time and fusion lengths were not associated with complications. There were 14 early perioperative complications and 18 late complications. There was 1 mortality case by pulmonary embolism. Early complications included G-I problems in 5 patients, postoperative delirium in 2 patients, superficial infection in 2 patients, and transient neurologic deficit in 1 patient. Late complications included 2 pseudarthrosis and 16 adjacent segment diseases. Adjacent segment disease developed at proximal segment in 11 patients and at distal segment in 5 patients. Revision surgery was performed in 6 patients for pseudarthrosis and adjacent segment disease. (See Table)
Conclusion: The overall incidence of complications of posterior fusion and instrumentation for degenerative lumbar scoliosis was 68%. Older age and abundant blood loss were risk factors for early perioperative complications. However, there was no factor related with late complications.
Table. Risk factors of complications
|
Early complications (n)
|
Late complications (n)
|
|
| Age (years): less than or equal to 65 (n=17) |
2
|
7 |
| Age (years): greater than or equal to 65 (n=30) |
12
(P=0.5) |
11 |
| Gender: M(n=8) |
1
|
2 |
| Gender: F (n=39) |
13
(P=0.4) |
16 |
| Smoking: Yes (n=6) |
1
|
3 |
| Smoking: No (n-41) |
13
(P=0.65) |
13 |
| No. of co-morbidity: 0 (n=20) |
8
|
8 |
| No. of co-morbidity: 1 (n=19) |
2
|
6 |
| No. of co-morbidity: less than or equal to 2 (n=8) |
4
(P›0.05) |
4 |
| Blood loss (ml): less than or equal to 2000 (n=24) |
3
|
9 |
| Blood loss (ml): › 2000 (n-23) |
11
(P=0.01) |
9 |
| Op. time (min): less than or equal to 200 (n=25) |
5
|
8 |
| Op. time (min): › 200 (n=22) |
9
(P=0.2) |
10 |
| Fusion level: less than or equal to 4 (n=28) |
6
|
11 |
| Fusion level: › 4 (n=19) |
8
(P=0.19) |
7 |
| Cobb angle (°): less than or equal to 20 (n=27) |
7
|
8 |
| Cobb angle (°): › 20 (n=20) |
7
(P=0.54) |
10 |
| Lumbar lordosis (°): less than or equal to 30 (n=23) |
7
|
8 |
| Lumbar lordosis (°): › 30 (n=24) |
7
(P=0.9) |
10 |
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