Our Summary

This study looked at the risk factors for developing a serious medical condition called rhabdomyolysis after spinal fusion surgery. Rhabdomyolysis happens when there’s a break down of muscle tissue that leads to the release of muscle fiber contents into the blood, which can cause heart rhythm problems, kidney failure, and even death.

The researchers analyzed 76 spinal fusion surgeries performed by one surgeon at two medical centers over a period of just over two years. They found that 22% of these surgeries resulted in rhabdomyolysis.

One significant finding was that being male increased the risk of developing rhabdomyolysis after surgery. Other factors that had been previously identified as potential risks, such as being younger, having a lower ASA score (which measures physical health), being overweight, having a higher creatinine level before surgery (which can indicate kidney problems), losing a lot of blood during surgery, the position of the patient during surgery, and the length of the surgery, were not found to be associated with rhabdomyolysis in this study.

The study also found that using a surgical approach called transpsoas, which involves going through the psoas muscle in the lower back, increased the risk of rhabdomyolysis. This was particularly the case if more levels of the spine were fused using this approach and if the patient’s psoas muscle was thicker.

The researchers concluded that being male and having more levels of the spine fused using the transpsoas approach increased the risk of developing rhabdomyolysis after spinal fusion surgery, especially if the patient did not have a second surgery within seven days or had a simultaneous posterior fusion.

FAQs

  1. What is rhabdomyolysis and what risk does it pose to patients undergoing spinal fusion surgery?
  2. What factors were found to increase the risk of developing rhabdomyolysis after spinal fusion surgery?
  3. How does the surgical approach, specifically the transpsoas approach, affect the risk of rhabdomyolysis?

Doctor’s Tip

A helpful tip a doctor might tell a patient about spinal surgery is to closely monitor for symptoms of rhabdomyolysis, such as muscle pain, weakness, and dark urine, after surgery. It’s important to seek immediate medical attention if any of these symptoms occur, as early detection and treatment can help prevent serious complications. Additionally, patients should follow their post-operative care instructions carefully, including proper wound care, physical therapy, and pain management, to optimize their recovery and reduce the risk of complications. Regular follow-up appointments with their healthcare provider are also essential to monitor their progress and address any concerns.

Suitable For

Patients who may be recommended for spinal surgery include those with severe back or neck pain that does not improve with conservative treatments such as physical therapy, medications, or injections. Other conditions that may warrant spinal surgery include spinal stenosis, herniated discs, degenerative disc disease, spinal deformities, spinal fractures, or spinal tumors. Additionally, patients with progressive neurological symptoms such as weakness, numbness, or tingling in the extremities may also be candidates for spinal surgery. Ultimately, the decision to undergo spinal surgery is individualized and should be made in consultation with a spine specialist after a thorough evaluation of the patient’s symptoms and imaging studies.

Timeline

Before spinal surgery:

  • Patient experiences chronic back pain, weakness, numbness, or tingling in the arms or legs
  • Patient undergoes imaging tests such as X-rays, MRI, or CT scans to determine the cause of their symptoms
  • Patient consults with a spine surgeon to discuss treatment options, including the possibility of spinal surgery
  • Patient undergoes pre-operative testing and preparation, such as blood tests and medical clearance from other specialists if needed

After spinal surgery:

  • Patient is monitored closely in the recovery room immediately after surgery
  • Patient may experience pain and discomfort at the surgical site, which is managed with pain medications
  • Patient begins physical therapy and rehabilitation to strengthen the muscles supporting the spine and improve mobility
  • Patient follows a post-operative care plan, which may include restrictions on certain activities and instructions for wound care
  • Patient attends follow-up appointments with the surgeon to monitor healing progress and address any concerns or complications that may arise.

What to Ask Your Doctor

  1. What is the specific surgical approach you will be using for my spinal fusion surgery?
  2. What are the potential risks and complications associated with this type of surgery?
  3. How will my physical health and medical history impact the likelihood of developing rhabdomyolysis after surgery?
  4. Are there any pre-existing conditions or medications that could increase my risk for rhabdomyolysis?
  5. How will you monitor me for signs of rhabdomyolysis during and after the surgery?
  6. What steps will be taken to prevent or manage rhabdomyolysis if it does occur?
  7. How long is the typical recovery period after spinal fusion surgery, and what can I expect in terms of pain management and rehabilitation?
  8. What are the chances of needing a second surgery or experiencing complications related to the fusion process?
  9. Are there alternative treatments or surgical approaches that could reduce the risk of rhabdomyolysis in my specific case?
  10. How many spinal fusion surgeries have you performed, and what is your success rate in terms of preventing complications like rhabdomyolysis?

Reference

Authors: Pressman E, Osburn B, Vivas A, Krafft P, Ljubimov V, Chen L, Mhaskar R, Alikhani P. Journal: Br J Neurosurg. 2024 Feb;38(1):29-34. doi: 10.1080/02688697.2020.1866164. Epub 2021 Jan 7. PMID: 33410353