Early Complications of Posterior Lumbar Transpedicular Screw Fixation in a Resource-Limited Setting: A Prospective Two-Year Cohort Study fromYemen.

Abstract

Posterior lumbar transpedicular screw fixation (TPSF) is widely used to manage spinal instability, yet prospective data from conflict-affected, resource-limited settings are limited. This study evaluated early postoperative complications and associated risk factors following TPSF in a tertiary hospital in Yemen. A prospective cohort study was conducted between January 2023 and December 2024. Adult patients undergoing open posterior lumbar TPSF for degenerative, traumatic, or spondylolisthetic pathology were followed for 30 days postoperatively. Demographic, clinical, and operative variables were recorded. Associations with complications were assessed using Fisher's exact test. Prolonged hospital length of stay (LOS) > seven days was analyzed using logistic regression. Fifty-one patients were included (mean age 45 ± 15 years; 71% male). Early postoperative complications occurred in 13 patients (25%). Neurological complications were most frequent (10%), followed by surgical site infection (6%). Preoperative neurological weakness (RR: 3.53; 95% CI 1.60-7.67; P = 0.046) and multilevel fixation (≥3 levels) (RR: 3.92; 95% CI: 1.80-8.58; P = 0.008) were significantly associated with higher complication risk. Complications were associated with prolonged LOS (OR: 83.3; 95% CI: 8.3-838; P = 0.001). Early postoperative complications following TPSF were within the higher range of internationally reported series. Preoperative neurological deficits and multilevel fixation were associated with increased risk. These findings highlight the importance of preoperative assessment, establishing stronger perioperative infection-control practices, and enhancing postoperative monitoring, which may improve surgical safety and recovery in low-resource environments.