TY  - JOUR
PY  - 2021//
TI  - Cervical spine injuries with acute traumatic spinal cord injury - spinal surgery adverse events and their association with neurological and functional outcome
JO  - Spine
A1  - Liebscher, Thomas
A1  - Ludwig, Johanna
A1  - Lübstorf, Tom
A1  - Kreutzträger, Martin
A1  - Auhuber, Thomas
A1  - Grittner, Ulrike
A1  - Schäfer, Benedikt
A1  - Wüstner, Grit
A1  - Ekkernkamp, Axel
A1  - Kopp, Marcel A.
SP  - ePub
EP  - ePub
VL  - ePub
IS  - ePub
N2  - STUDY DESIGN: Monocenter case-control study. <br><br>OBJECTIVE: Effects of spinal surgical adverse events (SSAE) on clinical and functional outcome, length of stay, and treatment costs after traumatic cervical spinal cord injury (SCI). SUMMARY OF BACKGROUND DATA: Traumatic SCI is a challenge for primary care centers because of the emergency setting and complex injury patterns. SSAE rates of up to 15% are reported for spine fractures without SCI. Little is known about SSAE after traumatic SCI and their outcome relevance. <br><br>METHODS: Acute traumatic cervical SCI patients were enrolled from 2011-2017. Cases with and without SSAE were compared regarding neurological recovery, functional outcome, secondary complications, mortality, length of stay and treatment costs. Adjusted logistic regression and generalized estimating equation models were calculated for the endpoints ASIA impairment scale (AIS)-conversion and dysphagia. All analyses were run in the total and in a propensity score matched sample. <br><br>RESULTS: At least one SSAE occurred in 37 of 165 patients (22.4%). Mechanical instability and insufficient spinal decompression were the most frequent SSAE with 13 (7.9%) or 11 (6.7%) cases, respectively. The regression models adjusted for demographic, injury, and surgery characteristics demonstrated a reduced probability for AIS-conversion related to SSAE [OR (95%CI) 0.14 (0.03-0.74)] and additionally to single-sided ventral or dorsal surgical approach [0.12 (0.02-0.69)] in the matched sample. Furthermore, SSAE were associated with higher risk for dysphagia in the matched [4.77 (1.31-17.38)] and the total sample [5.96 (2.07-17.18)]. Primary care costs were higher in cases with SSAE [Median (IQR) 97,300 (78,200-112,300)] EUR compared to cases without SSAE [52,300 (26,700-91,200)] EUR. <br><br>CONCLUSIONS: SSAE are an important risk factor after acute traumatic cervical SCI with impact on neurological recovery, functional outcome, and healthcare costs. Reducing SSAE is a viable means to protect the limited intrinsic capacity for recovery from SCI.Level of Evidence: 4.<p />  <p>Language: en</p>
LA  - en
SN  - 0362-2436
UR  - http://dx.doi.org/10.1097/BRS.0000000000004124
ID  - ref1
ER  -