Schwender James D, Casnellie Michael T, Perra Joseph H, Transfeldt Ensor E, Pinto Manuel R, Denis Francis, Garvey Timothy A, Polly David W, Mehbod Amir A, Dykes Daryll C, Winter Robert B, Wroblewski Jill M
Twin Cities Spine Center, 913 East 26th Street, Minneapolis, MN 55404, USA.
Spine (Phila Pa 1976). 2009 Jan 1;34(1):87-90. doi: 10.1097/BRS.0b013e3181918ad0.
This is a retrospective review of 129 consecutive anterior lumbar revision surgeries in 108 patients. It is a single-center, multi-surgeon study.
To determine occurrence rates and risk factors for perioperative complications in revision anterior lumbar fusion surgery.
Although complication rates from large series of primary anterior fusion procedures have been reported, reports of complication rates for revision anterior fusion procedures are relatively rare. Concern exists chiefly about the risk to vascular and visceral structures because of scar tissue formation from the original anterior exposure.
This was a retrospective review of 129 consecutive anterior revision lumbar surgeries in 108 patients operated between 1998 and 2003. There were 40 men and 68 women. The age of patients ranged from 25 to 83 (average 50.6 years). Patients were excluded if surgery was for tumor or infection. Patients were divided into 2 groups; those with revision surgery at the same level and those with revision surgery at an adjacent level. Outcome measures included all perioperative complications. Statistical analysis included Student t test and nonparametric sign-rank.
The number of surgical levels treated for revision was similar between the 2 groups (1 level 69%; 2 levels 19%; 3 or more levels 12%). Revision cases at the same operative level had a higher overall complication rate (42%) compared with extensions (20%; P = 0.007). This difference was primarily because of vein lacerations (23.7% vs. 3.6%, P = 0.002). There were 2 ureteral problems, both successfully salvaged. There were no arterial injuries or deaths.
Complication rates for revision lumbar surgery in this series were 3 to 5 times higher than reported for primary lumbar exposures. Complication rates were significantly higher for revision anterior lumbar fusions at the same segment, which were typically in the lower lumbar spine, compared with cases involving extensions, which were typically in the upper lumbar spine.
这是一项对108例患者连续进行的129例腰椎前路翻修手术的回顾性研究。这是一项单中心、多外科医生参与的研究。
确定腰椎前路翻修融合手术围手术期并发症的发生率及危险因素。
虽然已有大量关于初次前路融合手术并发症发生率的报道，但关于前路翻修手术并发症发生率的报道相对较少。主要担忧的是由于初次前路手术暴露后形成的瘢痕组织对血管和内脏结构造成的风险。
这是一项对1998年至2003年间接受手术的108例患者连续进行的129例腰椎前路翻修手术的回顾性研究。其中男性40例，女性68例。患者年龄在25岁至83岁之间（平均50.6岁）。因肿瘤或感染接受手术的患者被排除。患者分为两组；在同一节段进行翻修手术的患者和在相邻节段进行翻修手术的患者。观察指标包括所有围手术期并发症。统计分析包括学生t检验和非参数符号秩检验。
两组接受翻修手术的节段数量相似（1个节段69%；2个节段19%；3个或更多节段12%）。与相邻节段翻修病例（20%；P = 0.007）相比，同一手术节段的翻修病例总体并发症发生率更高（42%）。这种差异主要是由于静脉撕裂（23.7%对3.6%，P = 0.002）。有2例输尿管问题，均成功处理。无动脉损伤或死亡病例。
本系列腰椎翻修手术的并发症发生率比初次腰椎手术报道的高3至5倍。与通常位于上腰椎的相邻节段翻修病例相比，同一节段的腰椎前路翻修融合手术并发症发生率显著更高，后者通常位于下腰椎。
