Serious complications evident in EDS patients after cervical spine surgery

Higher rates of infections, stokes noted in months after 'relatively safe procedure'

Marisa Wexler, MS avatar

by Marisa Wexler, MS |

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Compared with the general population, people with Ehlers-Danlos syndrome (EDS) are at a greater risk of complications following anterior cervical discectomy and fusion, a common surgery to treat damage to the cervical spine of the neck, a study reports.

“EDS presents a challenge to cervical spine fusion patients who are undergoing a relatively safe procedure,” the researchers wrote.

The study, “Outcomes Following Anterior Cervical Discectomy and Fusion in Patients With Ehlers-Danlos Syndrome,” was published in the Global Spine Journal.

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Significant differences in complications with EDS in months after surgery

Anterior cervical discectomy and fusion, abbreviated ACDF, involves removing a damaged disk in cervical spine, the vertebrae of the neck. This can help to alleviate pressure on the spinal cord, easing symptoms like pain and tingling.

A team led by scientists at the University of Virginia conducted an analysis aiming to assess the rate of complications for people with EDS who undergo ACDF.

“While isolated case reports have been published, large retrospective studies regarding the outcomes of EDS patients undergoing anterior cervical discectomy and fusion (ACDF) procedures have not been assessed given the paucity of patients with this condition,” the scientists wrote.

Using an insurance-based database called PearlDiver, the researchers identified 533 adults with EDS who had ACDF surgery. For comparison, they also identified 2,634 adults without EDS who underwent ACDF. The two groups were matched according to age, sex, tobacco use, and history of co-occurring health conditions like diabetes, heart disease, and depression.

Statistical analyses showed that people with EDS were at increased risk of major medical complications in the 90 days following ACDF. For example, the risks of a cerebrovascular accident or stroke — loss of blood flow to the brain, which can damage brain tissue — and of pneumonia (inflammation and fluid in the lungs caused by infection) were more than three times higher for EDS patients.

EDS patients were nearly three times as likely to have complications related to the surgical wound, and more than eight times as likely to have an infection at the surgical site. They also were significantly more likely to have the surgery fail (pseudarthrosis), and were significantly more likely to need additional surgeries for revision.

The risk of an emergency department visit within 90 days of surgery was more than three times higher among the EDS patients.

Other significantly more common issues among the EDS patients following ACDF included urinary tract infection, dysphagia (trouble swallowing), and deep vein thrombosis — a potentially life-threatening clotting condition.

“The results of this study indicate that patients with EDS are at an increased risk for medical complications as well as surgical complications following ACDF,” the researchers concluded.

The team stressed that it’s important for surgeons to talk to patients with EDS about these risks if ACDF is being considered so that informed choices can be made.

“Prior to surgical intervention, a proper understanding of potential postoperative risks of EDS diagnosis and evaluation for cervical spine instability could give insight into resulting complications,” the researchers wrote.