Glassman Steven D, Hamill Christopher L, Bridwell Keith H, Schwab Frank J, Dimar John R, Lowe Thomas G
Department of Orthopaedic Surgery, University of Louisville School of Medicine, Louisville, Kentucky, USA.
Spine (Phila Pa 1976). 2007 Nov 15;32(24):2764-70. doi: 10.1097/BRS.0b013e31815a7644.
Retrospective case-control series.
The purpose of this study is to determine whether perioperative complications alter subsequent clinical outcome measures in adult spinal deformity surgery.
Increasingly, the benefit of surgical intervention is being evaluated based on patient reported outcomes and standardized health related quality of life (HRQOL) measures. As improvement or deterioration in HRQOL scores becomes a standard for clinical evaluation in adult spinal deformity, the correlation between HRQOL outcome scores and historic benchmarks, such as curve correction, sagittal balance, fusion healing, or the occurrence of a complication, must be clarified.
This study analyzes a prospective multicenter data base for adult spinal deformity. Patients with major, minor, and no complications were matched using a logistic regression technique producing 46 patients in each group. Standardized outcome measures at baseline and at 1 year postop were compared.
Forty-seven major complications were reported in 46 patients. Sixty-two minor complications were noted in 46 patients. Comparison between the 3 complication groups revealed that 1-year postoperative outcome measures were not statistically different for the Scoliosis Research Society Outcomes Instrument, Medical Outcomes Short Form-36 (SF-12), Oswestry Disability Index, or Numerical Pain Scales. The only significant interaction was in the rate of change from preop to 1-year postop for the SF-12 general health subscale. For the group with major complications, SF-12 general health deteriorated by 2.1 points from preop to 1-year postop. During the same period, the group with minor complications experienced an improvement of 4.2 points and the group with no complications experienced an improvement of 1.5 points.
This study suggests that risk for minor complications may be a less substantial obstacle than previously assumed for surgical treatment in adult spinal deformity. In contrast, major complications were reported in approximately 10% of cases and adversely affected outcome as evidenced by the deterioration in SF-12 general health scores at 1 year after surgery.
回顾性病例对照系列研究。
本研究旨在确定围手术期并发症是否会改变成人脊柱畸形手术后续的临床结局指标。
越来越多地，手术干预的益处是基于患者报告的结局以及标准化的健康相关生活质量（HRQOL）指标来评估的。随着HRQOL评分的改善或恶化成为成人脊柱畸形临床评估的标准，必须阐明HRQOL结局评分与历史基准之间的相关性，例如曲线矫正、矢状面平衡、融合愈合或并发症的发生情况。
本研究分析了一个成人脊柱畸形的前瞻性多中心数据库。使用逻辑回归技术对发生严重、轻微和无并发症的患者进行匹配，每组产生46例患者。比较了基线和术后1年的标准化结局指标。
46例患者报告了47例严重并发症。46例患者出现了62例轻微并发症。3个并发症组之间的比较显示，对于脊柱侧弯研究学会结局量表、医学结局简表36（SF - 12）、奥斯威斯利功能障碍指数或数字疼痛量表，术后1年的结局指标在统计学上没有差异。唯一显著的交互作用是SF - 12总体健康子量表从术前到术后1年的变化率。对于发生严重并发症的组，SF - 12总体健康从术前到术后1年下降了2.1分。在同一时期，发生轻微并发症的组改善了4.2分，无并发症的组改善了1.5分。
本研究表明，对于成人脊柱畸形的手术治疗，轻微并发症的风险可能不像之前认为的那样是一个重大障碍。相比之下，约10%的病例报告了严重并发症，并且如术后1年SF - 12总体健康评分的恶化所证明的，严重并发症对结局产生了不利影响。
