Weistroffer Joseph K, Perra Joseph H, Lonstein John E, Schwender James D, Garvey Timothy A, Transfeldt Ensor E, Ogilvie James W, Denis Francis, Winter Robert B, Wroblewski Jill M
Twin Cities Spine Center, Minneapolis, MN 55404, USA.
Spine (Phila Pa 1976). 2008 Jun 1;33(13):1478-83. doi: 10.1097/BRS.0b013e3181753c53.
A retrospective study of complications with minimal 5-year follow-up of 50 adults with scoliosis with fusion from T10 or higher to S1.
To document the perioperative and long-term complications and instrumentation problems, and to attempt to determine variables which may influence these problems. It is not a study of curve correction, balance, or functional outcome.
Several previous studies from this and other centers have shown a relatively high complication rate for this select group of patients. Various fusion techniques (anterior, posterior, autograft, allograft), various instrumentation techniques, and various immobilization techniques have created confusion as to the best methodology to employ. Minimal 2-year follow-ups have been standard, but longer follow-ups have shown additional problems.
The study cohort consisted of 50 adult patients from a single center who had undergone corrective scoliosis surgery from T10 or higher to the sacrum and who had at least a 5-year minimum follow-up. The mean age was 54 years (range, 18-72), and the mean follow-up was 9.7 years (range, 5-26). All radiographs, office charts, and hospital charts were combed by an independent investigator for complications, which were divided into major and minor, as well as early, intermediate and late. The curvature values and corrections were the subject of a different article, and were not included in this study.
There were no deaths or spinal cord injuries. Six patients had nerve root complications, 4 of which totally recovered. Pseudarthrosis was seen in 24% of the patients, only 25% of which were detected within the 2-year follow-up period. Pseudarthrosis was most common at the lumbosacral level. There was no statistical difference in the pseudarthrosis rate between patients with sacral-only fixation versus iliac fixation. Painful implants requiring removal were noted in 11 of the 50 patients.
Long fusions to the sacrum in adults with scoliosis continue to have a high complication rate. As compared to the original publications in the 1980s (Kostuik and Hall, Spine 1983;8:489-500; Balderston et al, Spine 1986;11:824-9) the more recent articles have shown a reduction, but not elimination of the pseudarthrosis problem using segmental instrumentation and anterior fusion of the lumbar spine coupled with structural interbody grafting at L4-L5 and L5-S1. Two-year follow-up is inadequate as pseudarthrosis and painful implants often are detected later. Only 3 of the 12 patients with pseudarthrosis were detected within the first 2 years after surgery.
一项回顾性研究，对50例成人脊柱侧弯患者进行至少5年的随访，这些患者均接受了从T10或更高节段至S1的融合手术。
记录围手术期和长期并发症以及器械问题，并试图确定可能影响这些问题的变量。本研究并非关于曲线矫正、平衡或功能结果。
本中心和其他中心此前的多项研究表明，这一特定患者群体的并发症发生率相对较高。各种融合技术（前路、后路、自体骨移植、同种异体骨移植）、各种器械技术和各种固定技术使得采用何种最佳方法产生了混淆。标准的随访时间为至少2年，但更长时间的随访显示出了更多问题。
研究队列包括来自单一中心的50例成年患者，他们均接受了从T10或更高节段至骶骨的脊柱侧弯矫正手术，且至少有5年的随访。平均年龄为54岁（范围18 - 72岁），平均随访时间为9.7年（范围5 - 26年）。一名独立研究者梳理了所有的X光片、门诊病历和住院病历，以查找并发症，并将其分为严重和轻微并发症，以及早期、中期和晚期并发症。曲率值和矫正情况是另一篇文章的主题，本研究未纳入。
无死亡或脊髓损伤病例。6例患者出现神经根并发症，其中4例完全康复。24%的患者出现假关节形成，其中仅25%在2年随访期内被发现。假关节形成在腰骶部最为常见。仅行骶骨固定的患者与行髂骨固定的患者之间假关节形成率无统计学差异。50例患者中有11例因植入物疼痛需要取出。
成人脊柱侧弯患者进行至骶骨的长节段融合手术的并发症发生率仍然很高。与20世纪80年代的原始文献（Kostuik和Hall，《脊柱》1983年；8：489 - 500；Balderston等人，《脊柱》1986年；11：824 - 9）相比，近期的文章表明，采用节段性器械和腰椎前路融合术并结合L4 - L5和L5 - S1节段的结构性椎间植骨，假关节问题有所减少，但并未消除。2年的随访时间不足，因为假关节形成和植入物疼痛通常在后期才被发现。12例假关节形成患者中，只有3例在术后头2年内被发现。
