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Neurologic Complications, Reoperation, and Clinical Outcomes After Surgery for Vertebral Osteomyelitis
Jacob A Miller1, Rebecca L Achey, Adeeb Derakhshan
1*Cleveland Clinic Center for Spine Health, Cleveland Clinic, Cleveland, OH†Cleveland Clinic Lerner College of Medicine, Cleveland, OH‡Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, MD.
Study Design:
A consecutive retrospective cohort study from 2008 to 2013 at a single tertiary-care institution was conducted.
Objective:
The aim of the study was to characterize recovery from pain and neurologic deficit after surgery for vertebral osteomyelitis (VO), and identify incidence of postoperative adverse events.
Summary Of Background Data:
A minority of patients with VO require surgery. Although prior studies have characterized outcomes after medical management, the morbidity after surgery is poorly defined.
Methods:
The primary outcome was change from baseline in a Modified McCormick Scale (MMS, 1-5 scale), whereas secondary outcomes included reoperation and change in self-reported pain Visual Analog Scale (VAS, 0-10 scale). MMS and VAS were collected throughout the postoperative course as surrogates for neurologic function and degree of pain. Intraoperative, short-term postoperative (<30 d), and long-term neurologic complications were recorded. New-onset neurologic deficits in the postoperative period were considered neurologic complications.
Results:
Fifty patients were included; a majority (52%) presented with a neurologic deficit. The median length of follow-up was 18 months. A statistically significant improvement in MMS was observed by 12 months postoperatively, whereas an improvement in VAS was observed by 3 months. The mean improvement in MMS at last follow-up was 0.35, whereas the mean improvement in VAS was 3.40. One quarter of patients required reoperation. At 24 months postoperatively, 10% died, 26% underwent reoperation, 42% experienced a neurologic complication, and 60% experienced at least one of these 3 adverse events.
Conclusion:
This is the first study to investigate neurologic complications, reoperation, and pain in a longitudinal manner after surgery for VO. We observed statistically significant improvements in MMS and VAS in the postoperative period. Despite these improvements, the 24-month incidence of overall adverse events was 60%. Patients and clinicians should be aware of the clinical improvement but high incidence of adverse events after surgical management of VO.
Level Of Evidence:
4.
