Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA.
Spine (Phila Pa 1976). 2010 Jan 15;35(2):219-26. doi: 10.1097/BRS.0b013e3181c91180.
Retrospective study.
To analyze the prevalence of and reasons for unanticipated revision surgery in an adult spinal deformity population treated at one institution.
No recent studies exist that analyze the rate or reason for unanticipated revision surgery for adult spinal deformity patients over a long period.
All patients presenting for primary instrumented spinal fusion with a diagnosis of adult deformity at a single institution from 1985 to 2008 were reviewed using a prospectively acquired database. All surgical patients with instrumented fusion of > or =5 levels using hooks, hybrid, or screw-only constructs were identified. Patient charts and radiographs were reviewed to provide information as to the indication for initial and any subsequent reoperation. A total of 643 patients underwent primary instrumented fusion for a diagnosis of adult idiopathic scoliosis (n = 432), de novo degenerative scoliosis (n = 104), adult kyphotic disease (n = 63), or neuromuscular scoliosis (n = 45). The mean age was 37.9 years (range, 18-84). Mean follow-up for the entire cohort was 4.7 years, and 8.2 years for the subset of the cohort requiring reoperation (range, 1 month-22.3 years).
A total of 58 of 643 patients (9.0%) underwent at least one revision surgery and 15 of 643 (2.3%) had more than one revision (mean 1.3; range, 1-3). The mean time to the first revision was 4.0 years (range, 1 week-19.7 years). The most common reasons for revision were pseudarthrosis (24/643 = 3.7%; 24/58 = 41.4%), curve progression (13/643 = 2.0%; 13/58 = 20.7%), infection (9/643 = 1.4%; 9/58 = 15.5%), and painful/prominent implants (4/643 = 0.6%; 4/58 = 6.9%). Uncommon reasons consisted of adjacent segment degeneration (3), implant failure (3), neurologic deficit (1), and coronal imbalance (1). Revision rates over the follow-up period were: 0 to 2 years (26/58 = 44.8%), 2 to 5 years (17/58 = 29.3%), 5 to 10 years (7/58 = 12.1%), >10 years (8/58 = 13.8%).
Repeat surgical intervention following definitive spinal instrumented fusion for primary adult deformity performed at a single institution demonstrated a relatively low rate of 9.0%. The most common reasons for revision were predictable and included pseudarthrosis, proximal or distal curve progression, and infection.
回顾性研究。
分析一家机构治疗的成人脊柱畸形患者中意外翻修手术的发生率和原因。
目前尚无研究分析成人脊柱畸形患者在很长一段时间内意外翻修手术的发生率或原因。
使用前瞻性获得的数据库，对一家机构于 1985 年至 2008 年间因成人畸形就诊的所有接受一期器械性脊柱融合的患者进行回顾性分析。所有接受> =5 个节段钩、混合或单纯螺钉器械融合的手术患者均被识别。查阅患者病历和影像学资料，以提供初次手术和任何后续再手术的适应证信息。共有 643 例患者因成人特发性脊柱侧凸（n = 432）、新发退行性脊柱侧凸（n = 104）、成人后凸畸形（n = 63）或神经肌肉性脊柱侧凸（n = 45）接受了一期器械性融合。平均年龄为 37.9 岁（范围，18-84 岁）。整个队列的平均随访时间为 4.7 年，需要再次手术的队列亚组的随访时间为 8.2 年（范围，1 个月-22.3 年）。
共有 58 例（9.0%）患者接受了至少一次翻修手术，15 例（2.3%）患者接受了多次翻修（平均 1.3 次；范围，1-3 次）。第一次翻修的平均时间为 4.0 年（范围，1 周-19.7 年）。最常见的翻修原因是假关节形成（24/643 = 3.7%；24/58 = 41.4%）、曲线进展（13/643 = 2.0%；13/58 = 20.7%）、感染（9/643 = 1.4%；9/58 = 15.5%）和植入物疼痛/突出（4/643 = 0.6%；4/58 = 6.9%）。不常见的原因包括相邻节段退变（3）、植入物失败（3）、神经功能缺损（1）和冠状面失衡（1）。随访期间的翻修率为：0-2 年（26/58 = 44.8%）、2-5 年（17/58 = 29.3%）、5-10 年（7/58 = 12.1%）、>10 年（8/58 = 13.8%）。
在一家机构进行的成人脊柱畸形初次确定性器械性融合后再次进行手术干预的发生率相对较低，为 9.0%。最常见的翻修原因是可预测的，包括假关节形成、近端或远端曲线进展和感染。
