A Jaber1, S Hemmer1, R Klotz2, T Ferbert1, C Hensel1, C Eisner3, Y M Ryang4, P Obid5, K Friedrich6, W Pepke1, M Akbar7. 1. Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany. 2. Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. 3. Department of Anesthesiology and Critical Care Medicine, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. 4. Department of Neurosurgery, Helios Klinikum Berlin-Buch, Berlin, Germany. 5. Spinal Surgery and Scoliosis Centre, Asklepios Paulinen Clinic, Geisenheimer Straße 10, 65197, Wiesbaden, Germany. 6. Department of Internal Medicine IV, University Hospital of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany. 7. MEOCLINIC GmbH, Friedrichstraße 71, 10117, Berlin, Germany. michael.akbar@meoclinic.de.
Abstract
BACKGROUND: Bowel dysfunction after spinal surgery is often underestimated and if not treated in a timely manner can lead to undesirable surgical interventions or fatal complications. The current medical literature primarily focuses on bowel dysfunction as a result of spinal injury. OBJECTIVE: The purpose of this review is to explore this topic in evaluating current evidence regarding the causes of acute bowel dysfunction after elective spinal surgery, primarily the thoracolumbar spine. Since available evidence for recommendations of treatment is scarce, an interdisciplinary management approach for treatment of bowel dysfunction following spinal surgery is also formulated. MATERIAL AND METHODS: An extensive literature search was carried out on PubMed. Keywords that were used in the search included bowel dysfunction, obstruction, postoperative ileus, spinal surgery, spinal fusion, constipation, opioid-induced constipation, colonic pseudo-obstruction, ischemic colitis, immobility-induced bowel changes, epidural anesthesia and diet. Relevant studies were chosen and included in the review. The treatment approach used in the spine center of a university hospital was included. RESULTS: Current research mainly focuses on investigating the nature and symptomatology of chronic bowel dysfunction after spinal cord injury. Emphasis on the acute phase of bowel dysfunction in patients after elective spinal surgery is lacking. The comorbidities that exacerbate bowel dysfunction postoperatively are well-defined. There has been refinement and expansion of the pharmacological and nonpharmacological treatment that could be implemented. Enough evidence exists to provide sufficient care. CONCLUSION: Management of acute bowel dysfunction after spinal surgery requires a comprehensive and individualized approach, encompassing comorbidities, behavioral changes, medications and surgery. Close supervision and timely treatment could minimize further complications. Research is required to identify patients who are at a higher risk of developing bowel dysfunction after specific spinal procedures.
BACKGROUND:Bowel dysfunction after spinal surgery is often underestimated and if not treated in a timely manner can lead to undesirable surgical interventions or fatal complications. The current medical literature primarily focuses on bowel dysfunction as a result of spinal injury. OBJECTIVE: The purpose of this review is to explore this topic in evaluating current evidence regarding the causes of acute bowel dysfunction after elective spinal surgery, primarily the thoracolumbar spine. Since available evidence for recommendations of treatment is scarce, an interdisciplinary management approach for treatment of bowel dysfunction following spinal surgery is also formulated. MATERIAL AND METHODS: An extensive literature search was carried out on PubMed. Keywords that were used in the search included bowel dysfunction, obstruction, postoperative ileus, spinal surgery, spinal fusion, constipation, opioid-induced constipation, colonic pseudo-obstruction, ischemic colitis, immobility-induced bowel changes, epidural anesthesia and diet. Relevant studies were chosen and included in the review. The treatment approach used in the spine center of a university hospital was included. RESULTS: Current research mainly focuses on investigating the nature and symptomatology of chronic bowel dysfunction after spinal cord injury. Emphasis on the acute phase of bowel dysfunction in patients after elective spinal surgery is lacking. The comorbidities that exacerbate bowel dysfunction postoperatively are well-defined. There has been refinement and expansion of the pharmacological and nonpharmacological treatment that could be implemented. Enough evidence exists to provide sufficient care. CONCLUSION: Management of acute bowel dysfunction after spinal surgery requires a comprehensive and individualized approach, encompassing comorbidities, behavioral changes, medications and surgery. Close supervision and timely treatment could minimize further complications. Research is required to identify patients who are at a higher risk of developing bowel dysfunction after specific spinal procedures.
Entities:
Keywords:
Complications; Constipation; Fecal incontinence; Ileus; Ogilvie syndrome; Spinal surgery
Authors: Wesley M Durand; Jack H Ruddell; Adam E M Eltorai; J Mason DePasse; Alan H Daniels Journal: World Neurosurg Date: 2018-05-23 Impact factor: 2.104
Authors: Joshua D Nelson; Joshua A Urban; Thomas L Salsbury; Jason K Lowry; Kevin L Garvin Journal: J Bone Joint Surg Am Date: 2006-03 Impact factor: 5.284
Authors: Tae Hee Lee; Joon Seong Lee; Su Jin Hong; Jae Young Jang; Seong Ran Jeon; Dong Won Byun; Won Young Park; Soon Im Kim; Hyung Suk Choi; Jae Chul Lee; Ji Sung Lee Journal: J Neurogastroenterol Motil Date: 2015-01-01 Impact factor: 4.924