Risk factors may determine which patients may be at increased risk of major complications
Spinal stenosis is a narrowing of the open spaces within your spine, which can put pressure on your spinal cord and the nerves that travel through the spine. Spinal stenosis occurs most often in the neck and lower back, according to the Mayo Clinic.
Surgery for lumbar spinal stenosis is done to relieve pressure on the spinal cord or the nerve roots. During surgery, damaged parts of your spine are removed. In general, up to 80% of people are satisfied with the results of surgery for spinal stenosis however, symptoms can return several years later leaving patients to face another surgery.
Dr. Richard Deyo, MD, MPH, OHSU Professor and the Kaiser-Permanente Endowed Professor of Evidence-Based Medicine in the Department of Family Medicine at Oregon Health and Science University and colleagues determined rates of major medical complications wound complications and mortality among patients undergoing surgery for lumbar stenosis and examine risk factors for these complications.
Researchers examined data on 12,154 patients undergoing surgery for spinal stenosis in the lower (lumbar) spine at Veterans Affairs (VA) medical centers between 1998 and 2009. Researchers concentrated on identifying risk factors for major medical complications including acute myocardial infarction, stroke, pulmonary embolism, pneumonia, systemic sepsis, coma, and cardiac arrest.
Among the patients the researchers found major medical complications n 2.1%, wound complication 3.2% and 0.6% 90 day mortality. Major medical complications were strongly associated with age ranging from less than one for percent in those under 50 years and up to four percent for those aged 80 and older. American Society of Anesthesiologists (ASA) class was a strong predictor of complications.
Other increases of risk included certain medications for chronic diseases; insulin use and long term corticosteroid use. Lower preoperative functional status was also a risk factor for major medical complications. Fusion procedures were associated with higher complication rates than with decompression alone. After adjustment for comorbidity, age, and functional status, fusion procedures remained associated with higher medical complication rates than were decompressions alone (odds ratio = 2.85; 95% confidence interval, 2.14–3.78; P < 0.0001).
In their conclusion the researchers write “ASA class, age, type of surgery, insulin or corticosteroid use, and functional status were independent risk factors for major medical complications. These factors may help in selecting patients and planning procedures, improving patient safety.”
According to Dr. Deyo "Surgery for spinal stenosis is concentrated among older adults, for whom complications are more frequent than among middle-aged patients.”
"Prediction rules" based on such easily assessable risk factors "might improve surgical planning, the patient consent process, and strategies for reducing risk.”
This study appears in Spine.