PMID- 34027924 OWN - NLM STAT- MEDLINE DCOM- 20211213 LR - 20240404 IS - 1528-1159 (Electronic) IS - 0362-2436 (Print) IS - 0362-2436 (Linking) VI - 47 IP - 1 DP - 2022 Jan 1 TI - Cervical Spine Injuries with Acute Traumatic Spinal Cord Injury: Spinal Surgery Adverse Events and Their Association with Neurological and Functional Outcome. PG - E16-E26 LID - 10.1097/BRS.0000000000004124 [doi] AB - STUDY DESIGN: Monocenter case-control study. OBJECTIVE: Effects of spinal surgical adverse events (SSAE) on clinical and functional outcome, length of stay, and treatment costs after traumatic cervical spinal cord injury (SCI). SUMMARY OF BACKGROUND DATA: Traumatic SCI is a challenge for primary care centers because of the emergency setting and complex injury patterns. SSAE rates of up to 15% are reported for spine fractures without SCI. Little is known about SSAE after traumatic SCI and their outcome relevance. METHODS: Acute traumatic cervical SCI patients were enrolled from 2011 to 2017. Cases with and without SSAE were compared regarding neurological recovery, functional outcome, secondary complications, mortality, length of stay, and treatment costs. Adjusted logistic regression and generalized estimating equation models were calculated for the endpoints ASIA impairment scale (AIS)-conversion and dysphagia. All analyses were run in the total and in a propensity score matched sample. RESULTS: At least one SSAE occurred in 37 of 165 patients (22.4%). Mechanical instability and insufficient spinal decompression were the most frequent SSAE with 13 (7.9%) or 11 (6.7%) cases, respectively. The regression models adjusted for demographic, injury, and surgery characteristics demonstrated a reduced probability for AIS-conversion related to SSAE (OR [95% CI] 0.14 [0.03-0.74]) and additionally to single-sided ventral or dorsal surgical approach (0.12 [0.02-0.69]) in the matched sample. Furthermore, SSAE were associated with higher risk for dysphagia in the matched (4.77 [1.31-17.38]) and the total sample (5.96 [2.07-17.18]). Primary care costs were higher in cases with SSAE (median (interquartile range) 97,300 [78,200-112,300]) EUR compared with cases without SSAE (52,300 [26,700-91,200]) EUR. CONCLUSION: SSAE are an important risk factor after acute traumatic cervical SCI with impact on neurological recovery, functional outcome, and healthcare costs. Reducing SSAE is a viable means to protect the limited intrinsic capacity for recovery from SCI.Level of Evidence: 4. CI - Copyright (c) 2021 The Author(s). Published by Wolters Kluwer Health, Inc. FAU - Liebscher, Thomas AU - Liebscher T AD - Treatment Centre for Spinal Cord Injuries, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany. AD - Spinal Cord Injury Research (Neuroparaplegiology), Department of Neurology and Experimental Neurology, Charite - Universitatsmedizin Berlin, corporate member of Freie Universitat Berlin, Humboldt-Universitat zu Berlin, and Berlin Institute of Health, Berlin, Germany. FAU - Ludwig, Johanna AU - Ludwig J AD - Treatment Centre for Spinal Cord Injuries, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany. FAU - Lubstorf, Tom AU - Lubstorf T AD - Spinal Cord Injury Research (Neuroparaplegiology), Department of Neurology and Experimental Neurology, Charite - Universitatsmedizin Berlin, corporate member of Freie Universitat Berlin, Humboldt-Universitat zu Berlin, and Berlin Institute of Health, Berlin, Germany. FAU - Kreutztrager, Martin AU - Kreutztrager M AD - Treatment Centre for Spinal Cord Injuries, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany. FAU - Auhuber, Thomas AU - Auhuber T AD - Medical Management, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany. AD - University of Applied Sciences of the German Statutory Accident Insurance (HGU), Bad Hersfeld, Germany. FAU - Grittner, Ulrike AU - Grittner U AD - Institute of Biometry and Clinical Epidemiology, Charite - Universitatsmedizin Berlin, corporate member of Freie Universitat Berlin, Humboldt-Universitat zu Berlin, Berlin, Germany. AD - Berlin Institute of Health, Berlin, Germany. FAU - Schafer, Benedikt AU - Schafer B AD - Treatment Centre for Spinal Cord Injuries, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany. FAU - Wustner, Grit AU - Wustner G AD - Controlling, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany. FAU - Ekkernkamp, Axel AU - Ekkernkamp A AD - Clinic for Trauma Surgery and Orthopaedics, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany. FAU - Kopp, Marcel A AU - Kopp MA AD - Spinal Cord Injury Research (Neuroparaplegiology), Department of Neurology and Experimental Neurology, Charite - Universitatsmedizin Berlin, corporate member of Freie Universitat Berlin, Humboldt-Universitat zu Berlin, and Berlin Institute of Health, Berlin, Germany. AD - Berlin Institute of Health, QUEST - Center for Transforming Biomedical Research, Berlin, Germany. LA - eng PT - Journal Article PL - United States TA - Spine (Phila Pa 1976) JT - Spine JID - 7610646 SB - IM MH - Case-Control Studies MH - Cervical Vertebrae/surgery MH - Decompression, Surgical MH - Humans MH - *Spinal Cord Injuries/epidemiology/surgery MH - *Spinal Diseases MH - Treatment Outcome PMC - PMC8654254 EDAT- 2021/05/25 06:00 MHDA- 2021/12/15 06:00 PMCR- 2021/12/08 CRDT- 2021/05/24 10:01 PHST- 2021/05/25 06:00 [pubmed] PHST- 2021/12/15 06:00 [medline] PHST- 2021/05/24 10:01 [entrez] PHST- 2021/12/08 00:00 [pmc-release] AID - 00007632-202201010-00012 [pii] AID - SPINE162666 [pii] AID - 10.1097/BRS.0000000000004124 [doi] PST - ppublish SO - Spine (Phila Pa 1976). 2022 Jan 1;47(1):E16-E26. doi: 10.1097/BRS.0000000000004124.