Morbidity and mortality in the surgical treatment of 10,329 adults with degenerative lumbar stenosis

Clinical article

Kai-Ming G. Fu Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia;

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Justin S. Smith Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia;

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David W. Polly Jr. Department of Orthopedic Surgery, University of Minnesota;

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Joseph H. Perra Twin Cities Spine Center, Minneapolis, Minnesota;

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Charles A. Sansur Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia;

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Sigurd H. Berven Department of Orthopedic Surgery, University of California at San Francisco, California;

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Paul A. Broadstone Spine Surgery Associates, Chattanooga, Tennessee;

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Theodore J. Choma Orthopedic Surgery, University of Missouri, Columbia, Missouri;

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Michael J. Goytan Health Sciences Centre, Winnipeg, Manitoba, Canada;

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Hilali H. Noordeen Royal National Orthopaedic Hospital and Great Ormond Street Children's Hospital, London, United Kingdom;

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D. Raymond Knapp Jr. Orlando Health, Orlando, Florida;

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Robert A. Hart Department of Orthopedic Surgery, Oregon Health & Science University, Portland, Oregon;

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Reinhard D. Zeller Division of Orthopedic Surgery, Hospital for Sick Children, Toronto, Ontario, Canada;

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William F. Donaldson III Department of Orthopedic Surgery, University of Pittsburgh Physicians, Pittsburgh, Pennsylvania; and

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Oheneba Boachie-Adjei Hospital for Special Surgery, New York, New York

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Christopher I. Shaffrey Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia;

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Object

The purpose of this study was to evaluate the prospectively collected Scoliosis Research Society (SRS) database to assess the incidences of morbidity and mortality (M&M) in the operative treatment of degenerative lumbar stenosis, one of the most common procedures performed by spine surgeons.

Methods

All patients who underwent surgical treatment for degenerative lumbar stenosis between 2004 and 2007 were identified from the SRS M&M database. Inclusion criteria for analysis included an age ≥ 21 years and no history of lumbar surgery. Patients were treated with either decompression alone or decompression with concomitant fusion. Statistical comparisons were performed using a 2-sided Fisher exact test.

Results

Of the 10,329 patients who met the inclusion criteria, 6609 (64%) were treated with decompression alone, and 3720 (36%) were treated with decompression and fusion. Among those who underwent fusion, instrumentation was placed in 3377 (91%). The overall mean patient age was 63 ± 13 years (range 21–96 years). Seven hundred nineteen complications (7.0%), including 13 deaths (0.1%), were identified. New neurological deficits were reported in 0.6% of patients. Deaths were related to cardiac (4 cases), respiratory (5 cases), pulmonary embolus (2 cases), and sepsis (1 case) etiologies, and a perforated gastric ulcer (1 case). Complication rates did not differ based on patient age or whether fusion was performed. Minimally invasive procedures were associated with fewer complications and fewer new neurological deficits (p = 0.01 and 0.03, respectively).

Conclusions

The results from this analysis of the SRS M&M database provide surgeons with useful information for preoperative counseling of patients contemplating surgical intervention for symptomatic degenerative lumbar stenosis.

Abbreviations used in this paper:

IRB = institutional review board; M&M = morbidity and mortality; SRS = Scoliosis Research Society.
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