The Predictors of Surgical Complications in the Treatment of Patients with Post-Traumatic Deformities of the Lower Thoracic and Lumbar Spine

Objectives : To identify predictors of complications in corrective surgeries in patients with post-traumatic deformities of the lower thoracic and lumbar spine. Materials and methods : A total of 152 adult patients with post-traumatic deformities of the lower thoracic and lumbar spine were included. The patients were divided into two groups depending on the correction method. Each group was subdivided into two subgroups: Group 1 (n=64) consisted of patients who underwent staged surgical treatment, which included correction using an external fixation device. It was followed by ventral or dorsal stabilization of the injured spinal motion segments, reconstruction of the anterior column and corporodesis. Depending on whether surgical mobilization of the injured spinal motion segments was performed prior to correction with external fixation, Group 1 was subdivided into subgroup 1.1 (n=46) and subgroup 1.2 (n=18). Group 2 (n=88) included patients who underwent single-stage surgical treatment involving correction through surgical mobilization of the injured spinal motion segments, transpedicular fixation, anterior column reconstruction, and corporodesis. Depending on the surgical approaches, Group 2 was divided into subgroup 2.1 (n=53) – procedures with combined approaches, and subgroup 2.2 (n=35) – procedures with the posterior approach. The analysis of factors influencing the incidence of complications included the methods of deformity correction, the complexity of deformities (angular or angulation-translation), the severity of preoperative neurological deficit, the localization of deformity, the duration of surgery, and the volume of blood loss. Conclusions : In the surgical treatment of post-traumatic deformities with posterior approaches, the most significant predictor of intraoperative cerebrospinal fluid leakage, wound infection, neurological complications, and partial loss of correction is the spondylometric complexity of the deformity with vertebral translation. In single-stage surgeries performed through combined approaches using the DVD sequence, deformity complexity with a translational component is a predictor of wound infection and respiratory complications. In posterior approach surgeries, the risk of neurological complications increases in patients with an initial absent or minimal neurological deficit. For staged treatment of post-traumatic deformities with preliminary repositioning of an external fixation device, no statistically significant predictors of complications were identified.