Passias et al identified risk factors for early complications after cervical spine surgeries. These can help to identify a patient who may benefit from more aggressive management. The authors are from NYU Langone Medical Center, State University of New York, Hospital for Special Surgery New York, the Johns Hopkins Hospital and Bordeaux University Hospital.
Patient selection: cervical spine surgery
Outcome: early complications (medical, surgical, revision, mortality)
Parameters:
(1) pulmonary circulatory disorder
(2) coagulopathy
(3) posterior approach to surgery
(4) metastatic or nonmetastatic cancer
(5) renal failure
(6) age in years
(7) congestive heart failure (CHF)
(8) levels fused or re-fused
(9) corpectomy
(10) alcohol abuse
(11) neurological disorder
(12) liver disease
(13) rheumatoid arthritis
(14) osteotomy
(15) chronic blood loss and/or anemia
|
Parameter
|
Finding
|
Points
|
|
pulmonary circulatory disorder
|
no
|
0
|
|
|
yes
|
10
|
|
coagulopathy
|
no
|
0
|
|
|
yes
|
5
|
|
posterior approach to surgery
|
no
|
0
|
|
|
yes
|
4
|
|
cancer history
|
none
|
0
|
|
|
nonmetastatic
|
2
|
|
|
metastatic
|
4
|
|
renal failure
|
no
|
0
|
|
|
yes
|
4
|
|
age in years
|
< 65 years
|
0
|
|
|
>= 65 years
|
3
|
|
congestive heart failure
|
no
|
0
|
|
|
yes
|
3
|
|
levels fused or refused
|
0 to 3
|
0
|
|
|
4 to 8
|
1
|
|
|
9 or more
|
3
|
|
corpectomy
|
no
|
0
|
|
|
yes
|
3
|
|
alcohol abuse
|
no
|
0
|
|
|
yes
|
2
|
|
neurological disorder
|
no
|
0
|
|
|
yes
|
2
|
|
liver disease
|
no
|
0
|
|
|
yes
|
1
|
|
rheumatoid arthritis
|
no
|
0
|
|
|
yes
|
1
|
|
osteotomy
|
no
|
0
|
|
|
yes
|
1
|
|
chronic blood loss, anemia
|
no
|
0
|
|
|
yes
|
1
|
total score =
= SUM(points for all 15 parameters)
Interpretation:
• minimum score: 0
• maximum score: 47 (paper reports 50 because of points for cancer and levels fused/refused)
• The higher the score the greater the risk of complications.
|
Total Score
|
Risk of Complications
|
|
0 to 10
|
mild
|
|
11 to 20
|
moderate
|
|
21 to 50
|
severe
|
