Michael H Moghimi1, Charles A Reitman2. 1. Department of Orthopedic Surgery, Baylor College of Medicine, 6620 Main St, Ste 1325, Houston, TX 77030, USA. 2. Department of Orthopedic Surgery, Baylor College of Medicine, 7200 Cambridge, Floor 10A, Houston, TX 77030, USA. Electronic address: creitman@bcm.edu.
Abstract
BACKGROUND CONTEXT: Only a small percentage of patients with spinal cord injury (SCI) require consideration for reconstructive surgery after their initial injury. For those who do, perioperative complications can be frequent and significant. There has been very little published literature examining treatment of these patients and essentially nothing to guide the surgeon in perioperative decision making and management. PURPOSE: To identify some of the common challenges associated with surgery in this patient population and review the literature to highlight the perioperative concerns in patients with chronic SCI. STUDY DESIGN: Review article. METHODS: A primary PubMed literature search was performed and reviewed for patients with chronic SCI with emphasis on the complications and difficulties encountered during surgical treatment of patients with chronic SCI. RESULTS: For those who do proceed with surgery in this patient population, preoperative nutrition, bone density, and skin should be evaluated and optimized. Preoperative inferior vena cava filters should be considered. The integrity of the reconstruction will be extensively challenged. In addition, augmented fixation and bracing should be contemplated. CONCLUSIONS: Patients with chronic SCI who require spinal reconstruction provide many unique challenges. Indications for surgery must be strong as perioperative complications can be frequent and long-term outcomes unpredictable. Close monitoring for postoperative complications is essential.
BACKGROUND CONTEXT: Only a small percentage of patients with spinal cord injury (SCI) require consideration for reconstructive surgery after their initial injury. For those who do, perioperative complications can be frequent and significant. There has been very little published literature examining treatment of these patients and essentially nothing to guide the surgeon in perioperative decision making and management. PURPOSE: To identify some of the common challenges associated with surgery in this patient population and review the literature to highlight the perioperative concerns in patients with chronic SCI. STUDY DESIGN: Review article. METHODS: A primary PubMed literature search was performed and reviewed for patients with chronic SCI with emphasis on the complications and difficulties encountered during surgical treatment of patients with chronic SCI. RESULTS: For those who do proceed with surgery in this patient population, preoperative nutrition, bone density, and skin should be evaluated and optimized. Preoperative inferior vena cava filters should be considered. The integrity of the reconstruction will be extensively challenged. In addition, augmented fixation and bracing should be contemplated. CONCLUSIONS:Patients with chronic SCI who require spinal reconstruction provide many unique challenges. Indications for surgery must be strong as perioperative complications can be frequent and long-term outcomes unpredictable. Close monitoring for postoperative complications is essential.
Authors: Peter G Passias; Gregory W Poorman; Edward Delsole; Peter L Zhou; Samantha R Horn; Cyrus M Jalai; Shaleen Vira; Bassel Diebo; Virginie Lafage Journal: Global Spine J Date: 2017-10-24