Elsevier

World Neurosurgery

Volume 102, June 2017, Pages 370-375
World Neurosurgery

Original Article
Increased 30-Day Complication Rates Associated with Laminectomy in 874 Adult Patients with Spinal Deformity Undergoing Elective Spinal Fusion: A Single Institutional Study

https://doi.org/10.1016/j.wneu.2017.03.096Get rights and content

Objective

Recent studies have reported that decompression with fusion leads to superior outcomes in correction of spinal deformity. The aim of this study was to determine if there is a difference in intraoperative and 30-day postoperative complication rates in patients undergoing spinal fusion with and without decompression.

Methods

Medical records of 874 adult (≥18 years old) patients with spinal deformity undergoing elective spinal fusion at a major academic institution from 2005 to 2015 were reviewed; 374 (42.8%) patients underwent laminectomy in addition to spinal fusion. The primary outcome investigated was the rate of intraoperative and 30-day complications.

Results

Patient demographics and comorbidities were similar between groups. The laminectomy cohort had significantly higher estimated blood loss (P < 0.0001), incidence of allogeneic blood transfusions (P = 0.0001), and rate of intraoperative durotomies (laminectomy cohort 10.4% vs. no-laminectomy cohort 3.1%; P < 0.0001). The laminectomy cohort had a significantly higher proportion of patients in the intensive care unit (28.6% vs. 17.7%; P < 0.001). There was no significant difference in 30-day readmission rate between cohorts (laminectomy cohort 13.0% vs. no-laminectomy cohort 9.8%; P = 0.13). Within 30 days after initial discharge, the laminectomy cohort had significantly higher rates of altered mental status (3.2% vs. 1.2%; P = 0.05), urinary tract infection (4.3% vs. 1.4%; P = 0.009), wound drainage (7.2% vs. 3.1%; P = 0.007), and instrumentation failure (1.1% vs. 0.0%; P = 0.03).

Conclusions

Patients undergoing spinal fusion with laminectomy may have higher complication rates than patients undergoing spinal fusion alone.

Introduction

Adult spinal deformity is a debilitating disease that affects both physical function and overall quality of life.1, 2 Most patients present with concomitant structural misalignment and stenosis. Accordingly, decompression with fusion may be necessary to remove the compressive elements on the neural tissue, while also achieving realignment of the spine.3

The efficacy of decompressive surgery in treating spinal stenosis is well documented.4, 5 Multiple studies have shown that decompression for spinal stenosis is associated with greater improvement of back pain, leg pain, and overall disability compared with conservative therapy.6, 7, 8 Furthermore, it has been reported that decompression in addition to fusion is superior to fusion alone in patients with spondylolisthesis and documented radiculopathy.9, 10 However, decompression in patients with degenerative spinal pathologies is associated with increased operative time and perioperative and postoperative complications. There is a paucity of studies comparing the postoperative complication profiles in patients undergoing fusion alone versus decompression with fusion for treatment of adult spinal deformities. The aim of this study was to compare intraoperative and 30-day postoperative complication rates between patients with spinal deformity undergoing spinal fusion with and without laminectomy.

Section snippets

Materials and Methods

In this retrospective study, we reviewed the medical records of 874 adult (≥18 years old) patients with spinal deformity who underwent elective spinal fusion at a major academic institution during the period 2005–2015. Institutional review board approval was obtained before initiation of the study. The preponderance of patients had degenerative scoliosis, with 270 patients (30.9%) with idiopathic deformity. Of patients, 374 (42.8%) underwent a laminectomy in addition to spinal fusion, and 500

Results

This study included 874 adult patients (no-laminectomy cohort, n = 500; laminectomy cohort, n = 374). There were no significant differences between cohorts in age (no-laminectomy cohort 63.2 years ± 12.1 vs. laminectomy cohort 64.6 years ± 11.5; P = 0.07), sex (no-laminectomy cohort 39.7% male vs. laminectomy cohort 39.1% male; P = 0.89), or body mass index (no-laminectomy cohort 28.6 kg/m2 ± 6.6 vs. laminectomy cohort 29.2 kg/m2 ± 6.6; P = 0.14) (Table 1). There were no significant differences

Discussion

In this retrospective study, we suggest that decompression with fusion may be associated with higher intraoperative and 30-day complication rates compared with fusion alone. Increased complication rates after combined decompression with fusion have been reported previously in the literature. In a randomized controlled trial of 228 patients, Forsth et al.11 showed that patients undergoing combined laminectomy and spinal fusion experienced greater estimated blood loss, operative time, and length

Conclusions

This study suggests that patients undergoing spinal fusion with laminectomy may have higher complication rates than patients undergoing spinal fusion alone. Further studies are necessary to corroborate our findings.

References (24)

  • K. Peddada et al.

    Clinical outcomes following sublaminar decompression and instrumented fusion for lumbar degenerative spinal pathology

    J Clin Neurosci

    (2016)
  • S. Kato et al.

    Risk of infectious complications associated with blood transfusion in elective spinal surgery—a propensity score matched analysis

    Spine J

    (2016)
  • S. Bess et al.

    The health impact of symptomatic adult spinal deformity: comparison of deformity types to United States population norms and chronic diseases

    Spine (Phila Pa 1976)

    (2016)
  • F. Pellise et al.

    Impact on health related quality of life of adult spinal deformity (ASD) compared with other chronic conditions

    Eur Spine J

    (2015)
  • T. Iguchi et al.

    Minimum 10-year outcome of decompressive laminectomy for degenerative lumbar spinal stenosis

    Spine (Phila Pa 1976)

    (2000)
  • A.S. Jakola et al.

    Clinical outcomes and safety assessment in elderly patients undergoing decompressive laminectomy for lumbar spinal stenosis: a prospective study

    BMC Surg

    (2010)
  • T. Amundsen et al.

    Lumbar spinal stenosis: conservative or surgical management? A prospective 10-year study

    Spine (Phila Pa 1976)

    (2000)
  • F.M. Kovacs et al.

    Surgery versus conservative treatment for symptomatic lumbar spinal stenosis: a systematic review of randomized controlled trials

    Spine (Phila Pa 1976)

    (2011)
  • A. Malmivaara et al.

    Surgical or nonoperative treatment for lumbar spinal stenosis? A randomized controlled trial

    Spine (Phila Pa 1976)

    (2007)
  • L.P. Johnson et al.

    Surgical management of isthmic spondylolisthesis

    Spine (Phila Pa 1976)

    (1988)
  • K. Kaneda et al.

    Distraction rod instrumentation with posterolateral fusion in isthmic spondylolisthesis. 53 cases followed for 18-89 months

    Spine (Phila Pa 1976)

    (1985)
  • P. Forsth et al.

    A randomized, controlled trial of fusion surgery for lumbar spinal stenosis

    N Engl J Med

    (2016)
  • Cited by (3)

    Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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