Prevention and treatment for early complications of posterior lumbar spinal surgery / 中华骨科杂志

ABSTRACT

objective To analyze the causes of early complications following posterior lumbar spinal operations and to find out about the way for prevention and treatment of those complications. Methods From 1998 to 2002, 903 patients underwent posterior lumbar spinal operations ,there were 587 males and 316 females , with an average age of 36.7years (range, 18 to 78 years ). The diagnosis of patients included lumbar disc prolapse in 483, lumbar stenosis in 145, lumbar spondylolisthesis in 96, lumbar fracture in 94, lumbar instability in 27, lumbar tuberculosis in 15 spinal tumors in 24 and reoperation in 19. All patients were evaluated by the medical history, clinical examination and review of the imaging data, and then the surgical plan was made respectively according to clinical evaluation. Results Early complications of 78 complications within 2 weeks post-operatively occurred in 76 cases with the incidence of 8.6%(78/903), in-cluding of 49 males and 27 females with an average age of 44.6 years. The complications consisted of 50 nerve root irritations(64.1%, 50/78), most of which relieved at 4 to 30 days after treatment, 9 gastrointesti-nal symptoms(11.5%, 9/78), all of which disappeared at 3 to 10 days but 2 cases needed enema, 4 hematomas of incisional wound(5.1%, 4/78), 4 cerebrospinal fluid leakages(5.1%, 4/78), 3 urinary reten-tions(3.9%, 3/78), 2 deep infections(2.6%, 2/78), 2 deep vein thrombosis(2.6%, 2/78), 2 pulmonary em-bolisms(2.6%, 2/78),1 infection of urinary tract(1.3%) and 1 fatty liquidization(1.3%, 1/78). The opera-tional procedure possible leading to surgical complication were laminectomy, nerve root dissection and in-strumentation. Conclusion Early complications may determine the clinical result of the posterior lumbar spinal operations. Besides the skilled technique, thorough pre-operative planning, close observation and proper management after operation, and early post-operative rehabilitations are of great benefit to the pre-vention and treatment of the complications.