[Perioperative complications of single-stage surgical management for spinal tuberculosis].

ABSTRACT

OBJECTIVE: To analyze the causes of perioperative complications of single-stage surgical management for spinal tuberculosis. METHODS: One hundred and twenty patients with thoracic, lumbar and lumbosacral spinal tuberculosis were treated by single-stage surgical management from January 1997 to January 2006 in our unit, including seventy-five males and forty-five females. The mean age was 34.5 (range 17 to 68) years old. The lesion ranged from T(6) to S(1). The anterior procedures of anterior debridement, interbody fusion and anterior fixation were carried out in sixty-five cases, posterior procedures in twenty-six cases, and combined anterior and posterior procedures in twenty-nine cases, respectively. The complications that occurred during surgical procedure and 1 month after operation were recorded. Underlying causes were analysed. RESULTS: There were 10 cases (8.3%) were recorded of mild to severe complications during perioperative period in 120 patients. The complications and underlying causes were as follows (1) A patient died from liver failure and blood coagulation dysfunction after operation due to inappropriate surgical timing (n = 1), in which case the patient with lumbosacral spinal tuberculosis also suffered from alcoholic liver sclerosis and dysfunction. (2) False diabetes insipidus (n = 1) and deep vein thrombosis of lower limbs (n = 1) occurred as result of surgical trauma. (3) Tear of iliac vein (n = 1) occurred with lumbosacral spinal tuberculosis because of unclear anatomical relationships when anterior debridement was performed. Injury of lumbar nerve roots (n = 3) and hemothorax (n = 1) also occurred due to mispractice of surgical procedures. (4) Paralysis intestinal obstruction and hypokalemia (n = 2) occurred after anterior procedures for lumbar spinal tuberculosis as a result of other reasons. CONCLUSIONS: Improper perioperative care will lead to complications of single-stage surgical procedures for spinal tuberculosis. Emphasis should be put on preoperative evaluation, surgical planning, and postoperative caring for prevention of complications.