Risk factors for early complications after anterior bone grafting and fusion surgery in patients with acute subaxial cervical spinal cord injury

English Keywords:Subaxial cervical spinal cord injury  Postoperative complication  Risk factors

English Abstract:

  【Abstract】 Objectives: To investigate the risk factors of early postoperative complications in patients with acute subaxial cervical spinal cord injury after anterior bone grafting and fusion surgery. Methods: The clinical data of 168 cases of traumatic cervical spinal cord injury who underwent anterior surgery in our hospital from January 2017 to November 2021 were retrospectively analyzed. There were 133 males and 35 females. The age ranged from 23 to 82 years, with an average age of 53.8±11.2 years. There were 33 patients with preoperative comorbidities(19.6%). ASIA classification of preoperative neurological impairment was as follows: 34 patients of grade A, 10 patients of grade B, 62 patients of grade C, and 62 patients of grade D. 50 patients were treated with high-dose methylprednisolone(29.8%). 135 cases(80.4%) were treated with anterior cervical discectomy and fusion(ACDF), and 33 cases(19.6%) were treated with anterior cervical corpectomy and fusion(ACCF). Early postoperative complications and death of patients during hospitalization period were collected. Univariate logistic regression analysis was used to evaluate possible relationships between early postoperative complications and the factors including sex, age, preoperative comorbidities, cause of injury, neurological level of injury, preoperative ASIA grade, whether there was brain, thoracic and abdominal injury, whether high-dose methylprednisolone treatment was used, time from injury to surgery, preoperative hemoglobin(HGB), preoperative albumin(ALB), extent of surgery, surgical method, operative time, and intraoperative blood loss. A multivariate logistic analysis was performed on the variables with P<0.2 in the univariate analysis to identify significant independent risk factors. Results: The incidence of early postoperative complications was 29.1%(49/168). Univariate logistic regression analysis showed that the cause of injury(P=0.032), preoperative ASIA grade(P＜0.001), whether combined with brain, thoracic and abdominal injury(P=0.043), whether high-dose methylprednisolone treatment was used(P=0.017), preoperative HGB(P=0.002), preoperative ALB(P=0.001) and surgical method(P=0.002) were correlated with early postoperative complications. Multivariate logistic regression analysis showed that preoperative ASIA grades A and B(P＜0.001, OR=5.389, 95%CI 2.243-12.950) and high-dose methylprednisolone treatment(P=0.044, OR=2.541, 95%CI 1.024-6.303) were independent risk factors for early postoperative complications. Conclusions: Preoperative ASIA grades A and B and high-dose methylprednisolone treatment are the independent risk factors for early postoperative complications in patients with acute subaxial cervical spinal cord injury.