Intra- and postoperative complications in the treatment of spinal metastases . A multicenter surveillance study from the German Spinal Registry (DWG-Register).

BACKGROUND: The incidence of spinal column tumors is estimated to be 0.62 per 100,000 individuals in the USA. It is especially important to understand the incidence and predictive factors for adverse events of surgery in spinal oncology patients, as a single complication may be associated with morbidity, mortality, and costs. The aim of the study was to use a large national registry to evaluate the perioperative cumulative incidence and predictors of major complications, for metastatic spinal tumors. METHODS: This study is a retrospective analysis of data from the DWG registry on patients who have undergone decompression with and without instrumentation undergoing tumor debulking, release of the neural structures, spinal stabilization or tumor extirpation in metastatic disease of the spine in 124 departments from January 2017 to January 2020, as well as vertebroplasty and percutaneous instrumentation. The outcomes evaluated were major complications defined by Finkelstein et al. as: death; cerebral (new postoperative coma or stroke), cardiac, pulmonary or renal complication; symptomatic venous thromboembolism; surgical site infection. RESULTS: In total, 1617 decompressions with and without instrumentation undergoing tumor debulking, release of the neural structures, spinal stabilization or tumor extirpation in metastatic disease in the spine were identified in the registry; N.=266 developed a major complication (group 2), while N.=1351 had no complication (group 1). The mean age in group 1 was 65 years (58.5%), in group 2 69 years (63.5%). In group 2, most of the patients had preoperatively an ASA Score of 3 and 4 (patients with severe general disease): 202/266 (75.9%) being significant. The overall prevalence of a major postoperative complication was 16.5% and for an intraoperative complication remained 8%. The likelihood ratio for major complications by blood loss greater than 500 mL were as follows: cardiovascular event with a likelihood of 4.22 pulmonary insufficiency 4.18 and cerebral 5.47. CONCLUSIONS: This analysis provides predictive models for surgeons to identify patients who may benefit from transitional care programs. Preoperative status, invasiveness, blood loss >500 mL and blood transfusions are independent predictors associated with higher risk of complication.

There is no difference in perioperative results between posterior instrumentation with and without interbody cage and debridement in primary spondylodiscitis in adults: a multicenter surveillance study from the German Spine Registry (DWG Register).

BACKGROUND: Primary spondylodiscitis is a medically challenging disease that can lead to recurrent back pain, progressive kyphotic deformity, and neurologic deficits. The incidence rate of primary non-tuberculosis spondylodiscitis has been estimated from 2.2 to 2.4 cases per 100,000 person-years, and it has been reported to be increasing because of the aging population. The objectives were to determine the safety and efficacy of posterior instrumentation (PI) with and without interbody cage, bony attachment and debridement in the treatment of primary spondylodiscitis by comparing perioperative data, functional outcomes, and overall infection-free survival. METHODS: Analysis of data from the DWG Registry on patients who have undergone posterior instrumentation with and without interbody cage, bony attachment and debridement in primary spondylodiscitis from the thoracolumbar junction to S1 (Th10-S1) at 10 institutions from January 2012 to December 2016. RESULTS: In total, 420 posterior instrumentations with and without interbody cage, bony attachment and debridement in primary spondylodiscitis in the thoracolumbar junction to S1 were identified in the registry; N.=138 were exclusively percutaneous posterior instrumented (PPI), while N.=102 underwent open posterior instrumentation (OPI) without interbody cage, bony attachment and debridement and N.=180 OPI with interbody cage, bony attachment and debridement. Clinical evaluation after surgery did not show a significant difference between groups including improvement of the mobilization and infection-free survival. However, with PPI the duration of operation and blood loss was significantly less than OPI with and without interbody cage, bony attachment and debridement. CONCLUSIONS: The results suggest interbody cage, bony attachment and debridement as not indispensable for treatment in primary spondylodiscitis. Therefore, we encourage the use of posterior stabilization alone in the treatment of spondylodiscitis as less invasive procedure reducing costs in instrumentation.