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Risks and Benefits of Spinal Internal Fixation: Are We Misinformed?
Author(s): ,
W. Selbi
Affiliations:
Department of Neurosurgery, Plymouth, United Kingdom
,
J. Yuen
Affiliations:
Department of Neurosurgery, Plymouth, United Kingdom
,
M. Nowell
Affiliations:
Department of Neurosurgery, Leeds Royal Infirmary, Leeds, United Kingdom
T. Germon
Affiliations:
Department of Neurosurgery, Plymouth, United Kingdom
EANS Academy. Selbi W. Oct 21, 2018; 225954; EP2131
Dr. Wisam Selbi
Dr. Wisam Selbi
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Abstract
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Background: Spinal instrumentation enables early mobilisation & avoids complications of prolonged bed rest. Surgeons are well-known to underestimate the complication rate of surgery but could also over-estimate the risks of bed rest. We identified patients treated with prolonged bed rest to manage spinal instability and recorded outcomes and complications.

Methods: Single centre, retrospective case series from 2010-2016. Patients identified through clinical coding (neurosurgical admission, no procedure +/- traction only, length of stay > 20 days). The study population included all those who had either elected to be treated conservatively and those in whom no other surgical strategy was available. We recorded demographics, underlying diagnosis, reason and duration of bed rest, complications and outcomes.

Results: 86 patients were identified using the above criteria of which 20 patients had spinal instability. Average age 53.5 (26-83). The mean duration of bed rest was 48.3 days. Underlying diagnosis was 15 traumatic, 4 infection and 1 tumour. 4 patients had cervical spine fractures managed with cervical traction.
5 had new neurological deficit on presentation. Reasons for opting for bed rest included osteoporosis (4), significant co-morbidities (4) and severe head injury (1) and others (including patients´ choice). Radiological follow-up was completed for 16 patients with evidence of satisfactory healing in 3-4 months (except for 1 patient). 1 patient deteriorated neurologically 10 months post-injury. 4 patients developed chest infection, 2 developed paralytic ileus. No DVTs/PEs and no significant pressure sores. 1 mortality after 60 days from cardiac event.

Conclusions: Prolonged bed rest for spinal instability does not have high rate of severe complications and outcomes are good. Perhaps we are undertaking surgery based on erroneous assumptions.
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