Complications and risk factors of short segment fusion for degenerative lumbar scoliosis

English Keywords:Short segment  Degenerative lumbar scoliosis  Complications  Risk factors

English Abstract:

  【Abstract】 Objectives: To review the surgical complications of short segmental lumbar fusion for degenerative lumbar scoliosis (DLS), and to analyze potential risk factors. Methods: From January 2011 to December 2015, 69 patients with degenerative lumbar scoliosis receiving short segmental lumbar fusion in our department were retrospectively investigated, including 28 males and 41 females. The mean age was 66.8±8.7 years old (range, 51-82 years). Clinical and surgical data were collected, including demographic information, BMI, hypertension, diabetes, heart disease, cerebrovascular disease, Cobb angle of lumbar scoliosis, preoperative lumbar lordosis, operation time, blood loss and transfusion, fusion segments and surgical complications(early and late). The correlations were analyzed between clinical factors and surgical complications using univariate analysis. Then the statistically significant indicators were integrated into Logistic regression analysis to determine the independent risk factors for complication. Results: The study cohort consisted of 69 cases, including 28 males and 41 females. A total of 17 cases(24.6%) developed surgical complications, while there were two complications in 2 individual patients each(2.9%), with no mortalities. Early complications included wound infection in 3 cases(4.3%, 2 cases of deep infection, 1 case of superficiality infection), cerebrospinal fluid leakage in 2 cases(2.9%), postoperative transient numbness or pain in lower limbs in 1 case(1.4%), epidural hematoma in 1 case(1.4%). Late complications included symptomatic adjacent segment degeneration (SASD) in 10 cases(14.5%) and revision in 3 cases(4.3%), internal fixation failure in 2 cases (rod falling off in 1 case and screw loosening in 1 case, 2.9%). The results of univariate analysis showed that the early complications were related to diabetes, intraoperative blood loss, operation time and fixed segment number(P<0.05); the late complications were related to Cobb angle of lumbar scoliosis, lumbar lordosis angle and fixed segment number(P<0.05). The multivariate Logistic regression analysis showed that the risk factors of early complications include operation time and fusion segments(P<0.05). The risk factors of late complications consist of Cobb angle of lumbar scoliosis and preoperative lumbar lordosis(P<0.05). Conclusions: Symptomatic adjacent segment degeneration is the most common complication of short segment lumbar fusion for degenerative lumbar scoliosis. The risk factors of early complications include operation time and fusion segments, and that of late complications include Cobb angle of lumbar scoliosis and preoperative lumbar lordosis.