Personal Practice SPINE INSTRUMENTATION: ASSESSMENT OF MORBIDITY RELATED TO 250 CASES

Study design: A retrospective review of the morbidity associated with 250 consecutive cases of spinal instrumentation carried out in a neurosurgical spine unit. Objectives: To examine associated risk factors and results of treatment of those patients who sustained morbidity as a result of spinal instrumentation. Methods: The case records and imaging of all patients who had undergone spinal instrumentation at any level for any pathology were studied for morbidity related to the instrumentation used. They were followed up between 3 months to 8 years. Results: Over an 8-year period 250 consecutive patients underwent spinal instrumentation and fusion performed by the senior author (RP). These included those at the cervical (171), thoracic (34), and the lumbar (45) spinal levels. The indications were for trauma, degenerative changes, tumours, tuberculosis and congenital anomalies. The average follow up period was 1.1 years (3 months 8 years). Of the 250 cases there was neurological deterioration observed in 6, in 4 there was root pain which recovered following removal of the pedicle screws. An intra op drop in SSEP was present in one patient which improved after removal of sub laminar wires and did not manifest as neurological deterioration post-op. There was an increased spasticity in 2 patients with Inter laminar clamps, who recovered following their removal. Conclusions: In experienced hands the neurological complications related to instrumentation is low. The infection rate can be kept to a minimum with meticulous technique. However its use should be confined to cases where clearly indicated.