Spinal Fusion Surgery Has No Added Risks for EDS Patients, Study Says

Researchers tap national insurance claims database of spinal surgery patients

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by Steve Bryson, PhD |

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spinal fusion surgery risks | Ehlers-Danlos News | illustration of patient heading to surgery

Spinal fusion surgery is not associated with additional complications for adults with Ehlers Danlos syndrome (EDS) compared with other patients undergoing the surgery, according to a large-scale analysis of insurance database information.

The most common reason for additional surgery in EDS patients five years after the initial spinal surgery was infection and complications with the implant.

These findings may be helpful for people diagnosed with EDS who are considering surgery, the researchers said.

The analysis, “Single-level posterior lumbar fusions in patients with Ehlers Danlos Syndrome not found to be associated with increased postoperative adverse events or five-year reoperations,” was published in the North American Spine Society Journal.

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EDS is a group of rare connective tissue diseases resulting from defects in the protein collagen and is marked by symptoms such as unusually mobile joints and soft, stretchy skin.

Due to hypermobility, some EDS patients may develop spinal problems, which may require surgery, particularly posterior lumbar fusion (PLF) — a surgical technique that fuses vertebrae in the lower back to stop painful excess motion. However, surgery in EDS has its own complications, including an increased risk of bleeding and poor wound healing.

Although, in general, PLF in adults has a high success rate, there is limited information about spinal surgery in adult EDS patients.

“The literature on orthopaedic surgery in EDS patients is sparse,” wrote a team led by researchers at the Yale School of Medicine in Connecticut.

What were the risks and survival rates after additional surgery?

Accordingly, the team investigated the risk of complications and survival after additional surgery in adults with EDS following single-level PLF, or fusion of only one spine segment.

Data were collected from the MSpine Pearldiver database, a large national insurance claims database that contains information on any patient who underwent a spinal procedure.

The team identified 170,342 people who had undergone PLF, of whom 242 (0.14%) had EDS. There were statistically significant differences between those with and without EDS with respect to age (44.33 vs. 59.61) and sex (86.8% female vs. 58.5%).

To address these differences, matching was done based on age, sex, and Elixhauser comorbidity index, a method to summarize comorbidities (co-existing conditions). As a result, the analysis focused on 239 EDS and 957 non-EDS PLF patients.

First, the scientists explored the incidence of adverse events (AEs) within 90 days of surgery. This included severe AEs such as surgical site infection, sepsis (overwhelming response to infection), blood clot-related conditions, heart attack and arrest, and inflammation of the pancreas. Minor AEs included pneumonia, urinary tract infection, kidney injury, impaired wound healing, blood transfusions, and bruising.

A statistical comparison between EDS and non-EDS PLF patients showed no differences in the incidence of surgical AEs when combined as either severe adverse events, minor adverse events, and any adverse event. After adjusting for age, sex, and comorbidity to account for any potential differences after matching, there were no statistical differences between the two groups.

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Then, the team examined the survival rate without any additional surgery within five years of PLF. This included procedures such as additional fusion, nerve decompression, fusion revision, or removal of supportive implants. At this time, data were available for 40.6% of EDS patients and 49.6% of non-EDS patients.

In the EDS group, there were 14 additional surgeries with a survival rate of 87.0%, while in the non-EDS group, there were 70 reoperations for a survival rate of 86.6%. Based on these numbers, there was no difference between the two groups. Similar results were observed when the researchers examined the first 90 days after surgery.

The most common cause for further surgery in the EDS group in the first 90 days and over five years was infection and complications with the implant.

“Based on the largest reported cohort of EDS patients undergoing single-level PLF, the current study found that adult EDS patients did not have any significant difference in 90-day adverse events, or 5-year reoperations compared to non-EDS patients,” the researchers wrote. “These findings may be useful for patient counseling and surgical planning for those with this rare condition.”