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Komplikationen im zeitlichen Verlauf nach einer operativen Wirbelsäulenversorgung

Peak timing for complications after spine surgery

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Zusammenfassung

Hintergrund

Postoperative Komplikationen in der Wirbelsäulenchirurgie sind häufig. Über die Zeitpunkte des jeweiligen Komplikationseintritts im postoperativen Verlauf wurde bisher nur spärlich berichtet. Die Erfassung der Häufigkeitsgipfel postoperativer Komplikationen hat jedoch wesentlichen Einfluss auf die Aufklärung der Patienten sowie die postoperativen Verlaufskontrollen.

Material und Methoden

In dieser monozentrischen retrospektiven Studie wurden die postoperativen Komplikationen von 1179 Patienten, die zwischen 2010 und 2015 mittels Spondylodese operativ versorgt worden waren, erfasst. Die Patienten wurden 3, 6, 12, 24 und 36 Monate postoperativ nachuntersucht. Gemäß der bestehenden Lokalisation und Pathologieart wurden die Patienten in Gruppen eingeteilt und die erfassten Komplikationen statistisch analysiert.

Ergebnisse

Aufgrund einer Komplikation wurde bei 16,9 % der 1179 Patienten eine Revision vorgenommen. Die meisten Komplikationen traten binnen der ersten 3 Monate auf (72,9 %). Der häufigste Grund für diese Revision war eine tiefe Wundinfektion (42,7 %). Die meisten Infektionen entwickelten die Patienten innerhalb der ersten 3 Monate nach der Operation (91,8 % aller Infektionen), sodass diese als Frühinfektionen definiert werden können. Der Häufigkeitsgipfel des Materialversagens zeigte sich im 2. postoperativen Jahr mit 46 % aller erfasster Materialversagen (2,5 % der Gesamtkomplikationen).

Diskussion

Der Häufigkeitsgipfel postoperativer Komplikationen nach Spondylodese tritt bereits innerhalb der ersten 3 postoperativen Monate ein. Die Wundinfektion stellt die häufigste Komplikation dar. Dennoch ist eine regelmäßige und langfristige postoperative klinisch-radiologische Verlaufskontrolle notwendig, da v. a. das Materialversagen erst innerhalb des 2. postoperativen Jahres einen Häufigkeitsgipfel aufweist.

Abstract

Background

Spine surgeries can pose many complications; however, peak timing of post-operative complications in the field of spine surgery is still not sufficiently delineated in the literature as yet. Nevertheless the determination of peak timing of post-operative complications has a significant influence on patient education and post-operative follow-up.

Materials and methods

This single-center study analyzed the medical records of 1179 patients that underwent spinal instrumentation between 2010 and 2015 at 3, 6, 12, 24 and 36 months postoperatively. Complications were analyzed according to their time of onset.

Results

Of the 1179 patients included, 199 (16.9%) underwent revision surgery due to a complication. Peak timing for complications (72.9%) occurred within the first 3 months after surgery. Infection was the most common reason for revision surgery (42.7%) and most infections occurred within the first 3 months after surgery (early infections) (91.8% of infections). Peak timing for material failure occurred in the second post-operative year (46% of all detected prosthesis failures) (2.5% of all complications).

Discussion

Peak timing of post-operative complications post spinal instrumentation occurs as early on as within the first 3 months after surgery and post-operative infections remain the most common post-operative complication overall. Nonetheless, regular and long-term postoperative clinical and radiological follow-up is crucial, since in particular prosthesis failure has its peak timing in the second post-operative year.

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Abbreviations

ALIF:

„Anterior lumbar interbody fusion“

ASD:

Adulte spinale Deformität

BWK:

Brustwirbelkörper

BWS:

Brustwirbelsäule

HWS:

Halswirbelsäule

LWS:

Lendenwirbelsäule

PJK:

Proximale junktionale Kyphose

PSO:

Pedikelsubtraktionsosteotomie

TLIF:

„Transforaminal lumbar interbody fusion“

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Authors and Affiliations

  1. Klinik für Orthopädie und Unfallchirurgie, Zentrum für Wirbelsäulenchirurgie, Universitätsmedizin Heidelberg, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland

    W. Pepke MD, C. Wantia, H. Almansour MD,  M. Thielen MD &  M. Akbar MD

  2. Institut für Medizinische Biometrie und Informatik, Universität Heidelberg, Heidelberg, Deutschland

    T. Bruckner

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  1. W. Pepke MD
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  2. C. Wantia
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  3. H. Almansour MD
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  4. T. Bruckner
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  6. M. Akbar MD
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Correspondence to M. Akbar MD.

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Interessenkonflikt

W. Pepke, C. Wantia, H. Almansour, T. Bruckner, M. Thielen und M. Akbar geben an, dass kein Interessenkonflikt besteht.

Diese Studie wurde durch die lokale Ethikkommission genehmigt (Ethikantragsnummer S‑471/2015).

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Pepke, W., Wantia, C., Almansour, H. et al. Komplikationen im zeitlichen Verlauf nach einer operativen Wirbelsäulenversorgung. Orthopäde 49, 39–58 (2020). https://doi.org/10.1007/s00132-019-03770-1

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