Article
Complications and outcome of patients with liver cirrhosis Child stages B&C after spinal instrumentation
Komplikationen und Outcome bei Patienten mit Leberzirrhose Stadium Child B&C nach instrumentierten Wirbelsäuleneingriffen
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Published: | June 4, 2021 |
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Objective: With this study we want to share our experience and outcome with patients with liver cirrhosis Child-Pugh stages B and C after instrumented spine surgery. We already know that patients with cirrhosis (Child-Pugh B & C) are high-risk patients due to their coagulation problems, higher infection risk, as well as osteopenia.
Methods: Between 2012 and 2020 we have operated on 14 patients with liver cirrhosis (Child-Pugh B & C) and spinal fractures (spontaneous and traumatic). All these patient underwent instrumented spinal surgery. This retrospective study is based on the patients’ conditions, intra- and postoperative complications, and the patient outcome scores.
Results: The study group comprised 14 cirrhotic patients (11 males and 3 females). The average age was 59 years (±26). The average length of stay was 36 days (±27). 4 (29%) patients were admitted with neurological deficits with hypoaesthesia, 10 (77%) patients were admitted with thoracolumbar pain. One patient was stabilised with wire cerclage due to dens fracture, 5 patients underwent dorsoventral instrumentation, and in 5 patients we performed only posterior fusion due to thoracic and lumbar vertebral body fractures. 1 patient received an ACDF with plating. 5 (35.5%) patients experienced postoperative material dislocation. One of these patient suffered postoperative paraparesis and also 5 (35.5%) of this group had to be re-operated on due to postoperative epidural bleeding. 4 of the patients had postoperative wound infections (28.6%) and one of them became septic (7.1%). Postoperative pain reduction was achieved in only three patients (21.4%). 7 (50.0) of the cohort required up-titration of their pain medication postoperatively and one patient had permanent paraparesis. One (7.1%) patient died postoperatively due to drastically deranged coagulation. The overall complication rate was about 78.6%.
Conclusion: In our experience, in most of patients with liver cirrhosis (Child-Pugh stages B & C) we were unable to improve the neurological or pain situation with spinal instrumentation. The risk of neurological complications and infections are markedly higher in patients with cirrhosis. These patients require in-depth and individualised evaluation before undergoing spine surgery with instrumentation.