Risk Factors And Cause Analysis Of Postoperative Complications After Posterior Lumbar Fusion

ObjectiveTo investigate risk factors,causes of postoperative complication after posterior lumbar fusion in lumbar degenerative diaease.MethodsAccording to the inclusion and exclusion criteria,674 patients with lumbar degenerative disease who were treated in the spine orthopedics department of the Third Affiliated Hospital of An Hui Medical University from October 2016 to August 2019 were included.There were 371 males and 301 females.Their age ranged from 46 to 77years(average 62.8 years).According to the statistics of diseases,there were 331 cases of lumbar disc herniation,166 cases of lumbar spinal stenosis,102 cases of lumbar spondylolisthesis,and 75 cases of degenerative lumbar scoliosis.According to the operation type,there were 201 cases of PLIF,259 cases of TLIF,40 cases of modified PLIF,and 174 cases of mis-TLIF.A total of 14 indicators were selected to evaluate the risk factors for postoperative complications based on the specific situation of our hospital and literature review,including age,gender,smoking,diabetes mellitus,hypertension,body mass index(BMI),osteoporosis,disease type,surgical method,operative segment,course of disease,doctor seniority,whether intraoperative screw placement was adjusted and operation length.By referring to electronic medical records,the data in the above indicators were recorded in detail and recorded into the statistical software.Using univariate analysis,the predicted risk factors were screened for further binary Logistic regression.ResultsAll patients were followed up for 1 to 6 months.61 cases of these 674 patients had the postoperative complications,including 23 cases of nerve injury(root symptoms),with an incidence of 3.41%(23/674).Cerebrospinal fluid leakage was found in 15 cases(2.23%(15/674)).There were 13 cases of combined infection,with an incidence of1.93%(13/674),and 10 cases of failure of internal fixators with an incidence of 1.48%(10/674)(including 4 cases of loosening and fracture of pedicle internal fixators).Intervertebral fusion cage was shifted in 6 cases.Univariate analysis showed that there were no significant differences in gender,body mass index(BMI),(P>0.1).There were significant differences in age,smoking,diabetes mellitus,hypertension,surgical methods,operation segment,disease type,course of disease,osteoporotic,doctor seniority,adjust nail position and operation length between patients with and without complications(P<0.1).The results of multivariate logistic regression analysis showed that smoking(OR=6.043,P=0.001),operative segment(P=0.000),course of disease(OR=2.926,P=0.033),osteoporotic(OR=8.430,P=0.000),adjust screw position(OR=9.813,P=0.000)are the independent risk factors for posterior lumbar fusion operation,the doctor seniority(OR=0.041,P=0.000)is an independent protective factor.ConclusionThere is a high incidence of nerve root stimulation symptom after surgery in lumbar degenerative diseases.Smoking,operative segment,course of disease,osteoporosis and intraoperative adjustment of screw position are independent risk factors for postoperative complications of lumbar posterior fusion.For patients with the above factors,doctors should evaluate the operation risk fully and selecting the best treatment plan.