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BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2016

Open Access 01-12-2016 | Research article

Unplanned revision spinal surgery within a week: a retrospective analysis of surgical causes

Authors: Tsung-Ting Tsai, Sheng-Hsun Lee, Chi-Chien Niu, Po-Liang Lai, Lih-Huei Chen, Wen-Jer Chen

Published in: BMC Musculoskeletal Disorders | Issue 1/2016

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Abstract

Background

The need for revision surgery after a spinal surgery can cause a variety of problems, including reduced quality of life for the patient, additional medical expenses, and patient-physician conflicts. The purpose of this study was to evaluate the causes of unplanned revision spinal surgery within a week after the initial surgery in order to identify the surgical issues most commonly associated with unplanned revision surgery.

Methods

We retrospectively reviewed the medical records of all patients at who received a spinal surgery at a regional medical center from July 2004 to April 2011 in order to identify those who required a revision surgery within one week of their initial surgery. Patients were excluded if they received a vertebroplasty, kyphoplasty, or nerve block surgery, because those surgeries are one-day surgeries that do not require hospital admission. In addition, patients with a primary diagnosis of wound infection were also excluded since reoperations for infection control can be expected.

Results

The overall incidence of unplanned revision spinal surgery during the time period covered by this review was 1.12 % (116/10,350 patients). The most common surgical causes of reoperation were screw malposition (41 patients), symptomatic epidural hematoma (27 patients), and inadequate decompression (37 patients). Screw malposition was the most common complication, with an incidence rate of 0.82 %. Screw instrumentation was significantly associated with revision surgery (p = 0.023), which suggests that this procedure carried a greater risk of requiring revision. The mean time interval to reoperation for epidural hematomas was significantly shorter than the intervals for other causes of revision spinal surgery (p < 0.001), which suggests that epidural hematoma was more emergent than other complications. Also, 25.93 % of patients who underwent hematoma removal experienced residual sequelae; this percentage was significantly higher than for other surgical causes of revision spinal surgery (p = 0.013).

Conclusions

The results suggest that to avoid the need for reoperation, screw malposition, inadequate decompression, and epidural hematoma are the key surgical complications to be guarded against. Accordingly, adequate decompression, epidural hematoma prevention, and proper pedicle screw placement may help reduce the incidence of revision surgery.
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Metadata
Title
Unplanned revision spinal surgery within a week: a retrospective analysis of surgical causes
Authors
Tsung-Ting Tsai
Sheng-Hsun Lee
Chi-Chien Niu
Po-Liang Lai
Lih-Huei Chen
Wen-Jer Chen
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2016
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-016-0891-4

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