Original Article

European Spine Journal

, Volume 21, Issue 12, pp 2680-2687

Lumbar spine fusion surgery and stroke: a national cohort study

  • Jau-Ching WuAffiliated withDepartment of Neurosurgery, Neurological Institute, Taipei Veterans General HospitalSchool of Medicine, National Yang-Ming UniversityInstitute of Pharmacology, National Yang-Ming University
  • , Yu-Chun ChenAffiliated withDepartment of Medical Research and Education, National Yang-Ming University HospitalInstitute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University Email author 
  • , Laura LiuAffiliated withDepartment of Ophthalmology, Chang Gung Memorial HospitalCollege of Medicine, Chang Gung University
  • , Wen-Cheng HuangAffiliated withDepartment of Neurosurgery, Neurological Institute, Taipei Veterans General HospitalSchool of Medicine, National Yang-Ming University
  • , Peck-Foong ThienAffiliated withDepartment of Pediatrics, National Yang-Ming University Hospital
  • , Tzeng-Ji ChenAffiliated withInstitute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University
  • , Henrich ChengAffiliated withDepartment of Neurosurgery, Neurological Institute, Taipei Veterans General HospitalSchool of Medicine, National Yang-Ming UniversityInstitute of Pharmacology, National Yang-Ming University
  • , Su-Shun LoAffiliated withDepartment of Surgery, School of Medicine, National Yang-Ming University

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Abstract

Purpose

To investigate the incidence and risk of stroke after lumbar spinal fusion surgery.

Method

Study subjects were identified from a nationwide cohort of 1 million people from 2000 to 2005 and were divided into the lumbar spinal fusion group (n = 2,015), who received posterior lumbar spinal fusion surgery, and the comparison group (n = 16,120) composed of age-, sex-, and propensity score-matched control subjects. The matching process was intended to adjust for demographics, comorbidities, and other immeasurable covariates to minimize selection bias. All subjects were followed up for 3 years for stroke, including hemorrhagic and ischemic strokes. Kaplan–Meier and Cox regression analyses were performed.

Results

The overall incidence rate of stroke in the cohort was 9.99 per 1,000 person-year. The lumbar spinal fusion group was less likely to have any stroke (adjusted hazard ratio (HR) = 0.83, p = 0.293), hemorrhagic stroke (adjusted HR = 0.74, p = 0.739) and ischemic stroke (adjusted HR = 0.81, p = 0.250) than the comparison group, but without significance.

Conclusions

Three years post-operatively, patients who received lumbar spinal fusion had stroke incidence rates similar to those without surgery. Posterior lumbar spinal fusion surgery is not associated with increased risks for any kind of stroke.

Keywords

Cerebrovascular accident Hemorrhagic stroke Ischemic stroke Lumbar fusion