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Appropriate patient selection may yield reduced morbidity in spinal resection

Careful selection of high-risk patients for immediate intervention with locoregional muscle flaps may reduce surgical complications in spinal resection procedures.

Researchers at a single institution reviewed experiences with reconstruction of spinal defects from 2002 through 2014. They aimed to identify risk factors that predicted wound morbidity, with a specific interest in the timing of reconstruction with ablative surgery, according to the results.

The analysis included 289 procedures performed in 259 patients.

Results indicated that 22.1% of the cohort experienced major wound complications necessitating reoperation. Lumbosacral defects occurred in 43.6% of the cohort.

In all defect regions, clinicians generally preferred paraspinous muscle flaps as the reconstructive method.

More than three-quarters (77.5%) of reconstructions were performed at the time of spinal procedure, while the remaining 22.5% were delayed due to complications from the prior surgical intervention.

Fewer instrumentation removal rates were required in patients who underwent immediate reconstruction compared to those with delayed reconstruction, (0.9% vs. 4.6%; P = .043). Patients undergoing immediate procedures also experienced fewer unplanned reoperations (0.5 vs. 1.3; P < .001) and lower mortality rates (0.9% vs. 9.2%; P < .001) than patients in the delayed reconstruction group.

Multivariable analysis results indicated that the presence of instrumentation increased the likelihood of major wound complication (OR = 3.2; P = .012). Wound complication rates also increased with the requirement of free flap (OR = 9; P = .016) and spinal cord exposure (OR = 2.6; P = .036). – by Rob Volansky

Disclosure: The researchers report no relevant financial disclosures.