Affiliations: Division of Trauma Surgery, Department of Surgery, University Hospital Zürich, Zürich, Switzerland
Correspondence:
[*]
Corresponding author: Thorsten Jentzsch, Division of Trauma Surgery, Department of Surgery, University Hospital Zürich, Rämistrasse 100, 8091 Zürich, Switzerland. Tel.: +41 44 255 27 55; Fax: +41 44 255 44 06, E-mail:thorsten.jentzsch@usz.ch, thorsten.jentzsch@gmail.com
Abstract: BACKGROUND: Fascial dehiscence after spinal instrumentation is usually located at
the mechanically stressed interscapular thoracic spine and often causes
cosmetic impairment and pain. However, therapy options remain barely
discussed. Synthetic meshes have been successfully used in the treatment of
abdominal hernias. OBJECTIVE: It was hypothesized that synthetic meshes are a successful treatment
option for spinal fascial dehiscence. METHODS: This retrospective study of a prospective database investigated all
consecutive patients who received a synthetic mesh for a fascial dehiscence
of the spine between 2010 and 2014 after prior spinal instrumentation.
Primary outcomes were healing of the fascial dehiscence, recurrence,
infection, revision, subjective satisfaction on a visual analog scale (VAS),
and the Oswestry Disability Index (ODI). Among others, secondary outcomes
consisted of seroma formation and return to work. The evaluated risk factors
consisted of the body mass index (BMI), outer abdominal fat (OAF), back
tissue, smoking, immunomodulatory therapy, preoperative radiation dose, and
instrumented levels. RESULTS: Sixteen patients with a mean follow up of 24 (SD 15) months were included. Every
fascial dehiscence successfully healed with the synthetic mesh and there
were no recurrences, infections or revisions. The mean subjective
satisfaction level was VAS 7.3 and the mean ODI was 26%. Five (31%)
patients had a seroma postoperatively, but did not show any differences in
the outcome (e.g. ODI of 28%). In the patient group < 65 years (n = 12),
all but two patients, who had work restrictions due to other diseases,
regained at least some capacity to work. Worse ODI scores were found for
patients with increased BMI, OAF, back tissue, cortisone therapy,
instrumented levels, preoperative radiation dose, and smokers. CONCLUSION: Synthetic meshes are a successful treatment option for spinal fascial
dehiscence, even seemingly in patients with a higher risk profile such as
obese and immunocompromised patients as well as in revision procedures. They
are associated with respectable cosmetic results, pain relief and clinical
outcome. Postoperatively, it is recommended to leave drains for more than
five to seven days in order to avoid seroma formation and to avoid weight
training for six weeks. Further prospective, comparative studies are
recommended.
Keywords: Synthetic mesh, spinal fascial dehiscence, instrumentation of the spine, Oswestry Disability Index (ODI), patient satisfaction
