الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Instrumented fusion of the lumbar spine by posterior approach is frequently used in the treatment of a variety of spinal disorders whether needed to treat neoplasm, infection, painful degenerative conditions, deformity or fracture.
The aim of this study was to evaluate perioperative complications associated with instrumented lumbar fusion used in treatment of different lumbar pathologies and to find out the incidence and risk factors of the different complications.
This work represented a prospective study of a clinical series of 50 patients operated using instrumented posterior lumbar fusion for the treatment of various lumbar pathological conditions.
This study included 29 men and 21 women, with a mean age of 43.7 years (range, 20-69 years). The indications for operating on these patients were; fracture in 15 patients, Spondylolisthesis in 11 patients, failed back syndrom in 8 patients, DDD in 7 cases, lumbar tumour in 5 patients and infection in 4 patients. All our patients were subjected to history taking, detailed clinical examination, and radiological investigations using radiographs, CT and MRI. Postoperative follow-up was achieved in all the patients at a mean of 8 months (range, 6-14 months) through clinical and radiological examination.
The most common posterior lumbar approach used in this study was TLIF approach in 22 cases (44%), posterolateral in 19 cases (38%), and PLIF in 9 cases (18%).
Single level of lumbar fusion occurred in 32 patients (64%) while multiple level of fusion occurred in 18 patients (36%).
The average skin incision length for our cases was 10 cm (range, 7-21). The mean blood loss per case was 350 cc (range, 50-1700 cc) and blood transfusion was required in 9 patients (18%). The mean operative time was 150 minutes (range, 120-250 minutes). Adequate surgical exposure could be achieved in all our cases and the target for which the posterior approach was chosen was completed successfully.
The overall complication rate was 50%. 8 patients (16%) with intraoperative complications and 17 patients(34%) with postoperative complications had occurred in this study. Dural tear represented the most common intraoperative complication and it occurred in 4 patients (8%), followed by 3 cases of significant epidural bleeding, and one case of inappropriate screw insertion and fracture pedicle. There were no major vascular injuries or nerve root tear in this study.
The most common postoperative complications was infection in 5 patients (10%), pseudoarthrosis in 4 patients (8%), nerve root injury in 3 patients (6%), instrument failure in 3 patients (6%), CSF leak in 2 patients (4%), and 1 case with DVT (2%).