Lumbar spine fusion surgery and stroke: a national cohort study.
OBJECTIVE
To investigate the incidence and risk of stroke after lumbar spinal fusion surgery.


METHODS
Study subjects were identified from a nationwide cohort of 1 million people from 2000 to 2005 and were divided into the lumbar spinal fusion group (n = 2,015), who received posterior lumbar spinal fusion surgery, and the comparison group (n = 16,120) composed of age-, sex-, and propensity score-matched control subjects. The matching process was intended to adjust for demographics, comorbidities, and other immeasurable covariates to minimize selection bias. All subjects were followed up for 3 years for stroke, including hemorrhagic and ischemic strokes. Kaplan-Meier and Cox regression analyses were performed.


RESULTS
The overall incidence rate of stroke in the cohort was 9.99 per 1,000 person-year. The lumbar spinal fusion group was less likely to have any stroke (adjusted hazard ratio (HR) = 0.83, p = 0.293), hemorrhagic stroke (adjusted HR = 0.74, p = 0.739) and ischemic stroke (adjusted HR = 0.81, p = 0.250) than the comparison group, but without significance.


CONCLUSIONS
Three years post-operatively, patients who received lumbar spinal fusion had stroke incidence rates similar to those without surgery. Posterior lumbar spinal fusion surgery is not associated with increased risks for any kind of stroke.
Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.
Jau-Ching
JC
Wu
Yu-Chun
YC
Chen
Laura
L
Liu
Wen-Cheng
WC
Huang
Peck-Foong
PF
Thien
Tzeng-Ji
TJ
Chen
Henrich
H
Cheng
Su-Shun
SS
Lo
D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D016016:Proportional Hazards Models; D012307:Risk Factors; D013123:Spinal Fusion / Q000009:adverse effects*; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology