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Bowel dysfunction after elective spinal surgery: etiology, diagnostics and management based on the medical literature and experience in a university hospital

Darmfunktionsstörung nach elektiver Wirbelsäulenoperation: Ätiologie, Diagnostik und Management nach der aktuellen Literatur und den Erfahrungen in einem Universitätsklinikum

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Abstract

Background

Bowel dysfunction after spinal surgery is often underestimated and if not treated in a timely manner can lead to undesirable surgical interventions or fatal complications. The current medical literature primarily focuses on bowel dysfunction as a result of spinal injury.

Objective

The purpose of this review is to explore this topic in evaluating current evidence regarding the causes of acute bowel dysfunction after elective spinal surgery, primarily the thoracolumbar spine. Since available evidence for recommendations of treatment is scarce, an interdisciplinary management approach for treatment of bowel dysfunction following spinal surgery is also formulated.

Material and methods

An extensive literature search was carried out on PubMed. Keywords that were used in the search included bowel dysfunction, obstruction, postoperative ileus, spinal surgery, spinal fusion, constipation, opioid-induced constipation, colonic pseudo-obstruction, ischemic colitis, immobility-induced bowel changes, epidural anesthesia and diet. Relevant studies were chosen and included in the review. The treatment approach used in the spine center of a university hospital was included.

Results

Current research mainly focuses on investigating the nature and symptomatology of chronic bowel dysfunction after spinal cord injury. Emphasis on the acute phase of bowel dysfunction in patients after elective spinal surgery is lacking. The comorbidities that exacerbate bowel dysfunction postoperatively are well-defined. There has been refinement and expansion of the pharmacological and nonpharmacological treatment that could be implemented. Enough evidence exists to provide sufficient care.

Conclusion

Management of acute bowel dysfunction after spinal surgery requires a comprehensive and individualized approach, encompassing comorbidities, behavioral changes, medications and surgery. Close supervision and timely treatment could minimize further complications. Research is required to identify patients who are at a higher risk of developing bowel dysfunction after specific spinal procedures.

Zusammenfassung

Hintergrund

Darmfunktionsstörungen nach Wirbelsäulenoperationen werden häufig unterschätzt und können bei nicht rechtzeitiger Behandlung zu Komplikationen und unerwünschten chirurgischen Eingriffen führen. In der aktuellen Literatur wird hauptsächlich das Thema der Darmmotilitätsstörung als Folge der Rückenmarkverletzung behandelt.

Ziel der Arbeit

Ziel dieser Übersichtsarbeit ist es, die Ätiologie der Darmfunktionsstörung nach einer elektiven Wirbelsäulenoperation, v. a. an der Brust- und Lendenwirbelsäule, zu erläutern. Da es zu dieser Thematik kaum Behandlungsempfehlungen gibt, wird auch ein interdisziplinärer Ansatz für die Behandlung von Darmfunktionsstörung nach Wirbelsäulenchirurgie formuliert.

Materialen und Methoden

Auf PubMed wurde eine umfangreiche Literaturrecherche durchgeführt. Die bei der Suche verwendeten Schlüsselwörter waren Darmstörung, Darmverschluss, postoperativer Ileus, Wirbelsäulenoperation, Wirbelsäulenversteifung, Obstipation, opioidinduzierte Obstipation, Kolon-Pseudoblockade, ischämische Kolitis, immobilitätsinduzierte Darmveränderungen, Epiduralanästhesie und Ernährung. Relevante Studien wurden ausgewählt und in die Übersicht aufgenommen. Der im Wirbelsäulenzentrum einer Universitätsklinik angewandte Behandlungsansatz wurde mit einbezogen.

Ergebnisse

Die aktuelle Forschung konzentriert sich hauptsächlich auf die Untersuchung der Art und Symptomatik der chronischen Darmfunktionsstörungen nach einer Rückenmarkverletzung. Ein Schwerpunkt hinsichtlich der akuten Phase der Darmfunktionsstörung bei Patienten nach elektiven Wirbelsäulenoperationen fehlt. Die Komorbiditäten, welche postoperativ zu einer Verschlechterung der Darmfunktionsstörung führen, sind gut definiert. Die medikamentöse und nichtmedikamentöse Behandlung wurde angepasst und erweitert. Es liegt genügend Evidenz für eine ausreichende Versorgung vor.

Fazit

Die Behandlung von akuten Darmfunktionsstörungen nach einer Wirbelsäulenoperation erfordert einen umfassenden und individuellen Ansatz unter Berücksichtigung der Komorbiditäten, Verhaltensänderungen, Medikation und Operationen. Eine engmaschige Überwachung und eine rechtzeitige Therapiebehandlung könnten weitere Komplikationen minimieren. Weitere Forschung ist erforderlich, um Patienten zu identifizieren, bei denen nach bestimmten Eingriffen an der Wirbelsäule ein höheres Risiko besteht, eine Darmfunktionsstörung zu entwickeln.

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Abbreviations

AGA:

American Gastroenterological Association

AIPO:

Acute intestinal pseudo-obstruction

BUN:

Blood urea nitrogen

CI:

Colonic ischemia

CT:

Computed tomography

MRI:

Magnetic resonance imaging

NSAID:

Nonsteroidal anti-inflammatory drug

OIC:

Opioid-induced constipation

PAMORA:

Peripherally acting µ‑opioid receptor antagonist

PI:

Paralytic ileus

SCI:

Spinal cord injury

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Authors and Affiliations

  1. Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany

    A. Jaber, S. Hemmer, T. Ferbert, C. Hensel & W. Pepke

  2. Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    R. Klotz

  3. Department of Anesthesiology and Critical Care Medicine, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    C. Eisner

  4. Department of Neurosurgery, Helios Klinikum Berlin-Buch, Berlin, Germany

    Y. M. Ryang

  5. Spinal Surgery and Scoliosis Centre, Asklepios Paulinen Clinic, Geisenheimer Straße 10, 65197, Wiesbaden, Germany

    P. Obid

  6. Department of Internal Medicine IV, University Hospital of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany

    K. Friedrich

  7. MEOCLINIC GmbH, Friedrichstraße 71, 10117, Berlin, Germany

    M. Akbar

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Correspondence to M. Akbar.

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A. Jaber, S. Hemmer, R. Klotz, T. Ferbert, C. Hensel, C. Eisner, Y.M. Ryang, P. Obid, K. Friedrich, W. Pepke and M. Akbar declare that they have no competing interests.

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For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case.

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Jaber, A., Hemmer, S., Klotz, R. et al. Bowel dysfunction after elective spinal surgery: etiology, diagnostics and management based on the medical literature and experience in a university hospital. Orthopäde 50, 425–434 (2021). https://doi.org/10.1007/s00132-020-04034-z

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