PERIOPERATIVE COMPLICATIONS OF ANTERIOR PROCEDURES ON THE SPINE

We reviewed the operative and hospital records of, 447 patients in ord er to determine the rates of perioperative complications associated,vi th an anterior procedure on the thoracic, thoracolumbar, or lumbar spi ne, The anterior procedures were performed to treat spinal deformity o r for debridement or decompression of the spinal canal, The diagnostic groups that we studied included idiopathic scoliosis in adolescents o r young adults (100 patients), scoliosis in mature adults (sixty-three patients), kyphosis (sixty-one patients), neuromuscular scoliosis (si xty patients), fracture (forty-seven patients), a revision procedure ( thirty-nine patients), congenital scoliosis (thirty-six patients), tum or (nineteen patients), vertebral osteomyelitis or discitis (eight pat ients), and miscellaneous (fourteen patients), Complications occurred in 140 (31 per cent) of the 447 patients and were classified as major or minor, Forty-seven patients (11 per cent) had at least one major co mplication and 109 (24 per cent) had at least one minor complication, Two patients died, both from pulmonary complications after the operati on, The most common type of major complication was pulmonary; the most common type of minor complication was genito-urinary, The adolescent or young adult patients who had idiopathic scoliosis had the lowest ra te of complications, and the patients who had neuromuscular scoliosis had the highest, An age of more than sixty years at the time of the op eration was associated with a higher risk of complications, The durati on of the procedures involving a thoracic approach was shorter than th at of those involving a thoracolumbar or lumbar approach; however, the rate of complications was not significantly different among the three approaches, Vertebrectomies took longer to perform and were associate d with a greater estimated blood loss than discectomies; however, ther e was no significant difference in the rate of complications between t he two types of procedures, The patients who had a fracture or a tumor lost more blood than those from the other diagnostic groups, Blood lo ss increased as the duration of the operation increased for all proced ures, Combined anterior and posterior procedures performed during the same anesthesia session were associated with a higher rate of major co mplications than were procedures that were staged, A logistical regres sion analysis showed that the variables that increased the risk of a m ajor complication were an estimated blood loss of more than 520 millil iters and an anterior and posterior procedure performed sequentially u nder the same anesthesia session, This analysis also demonstrated that the diagnosis of idiopathic scoliosis in adolescents or young adults was associated with a reduced risk of major complications, Compared wi th other major operations, an anterior procedure on the thoracic, thor acolumbar, or lumbar spine performed for the indications mentioned in this study is relatively safe.