Department of Neurosurgery, University of Maryland Medical Center, Baltimore, Maryland, USA.
J Neurosurg Spine. 2010 Nov;13(5):589-93. doi: 10.3171/2010.5.SPINE09529.
This is a retrospective review of 10,242 adults with degenerative spondylolisthesis (DS) and isthmic spondylolisthesis (IS) from the morbidity and mortality (M&M) index of the Scoliosis Research Society (SRS). This database was reviewed to assess complication incidence, and to identify factors that were associated with increased complication rates.
The SRS M&M database was queried to identify cases of DS and IS treated between 2004 and 2007. Complications were identified and analyzed based on age, surgical approach, spondylolisthesis type/grade, and history of previous surgery. Age was stratified into 2 categories: > 65 years and ≤ 65 years. Surgical approach was stratified into the following categories: decompression without fusion, anterior, anterior/posterior, posterior without instrumentation, posterior with instrumentation, and interbody fusion. Spondylolisthesis grades were divided into low-grade (Meyerding I and II) versus high-grade (Meyerding III, IV, and V) groups. Both univariate and multivariate analyses were performed.
In the 10,242 cases of DS and IS reported, there were 945 complications (9.2%) in 813 patients (7.9%). The most common complications were dural tears, wound infections, implant complications, and neurological complications (range 0.7%-2.1%). The mortality rate was 0.1%. Diagnosis of DS had a significantly higher complication rate (8.5%) when compared with IS (6.6%; p = 0.002). High-grade spondylolisthesis correlated strongly with a higher complication rate (22.9% vs 8.3%, p < 0.0001). Age > 65 years was associated with a significantly higher complication rate (p = 0.02). History of previous surgery and surgical approach were not significantly associated with higher complication rates. On multivariate analysis, only the grade of spondylolisthesis (low vs high) was in the final best-fit model of factors associated with the occurrence of complications (p < 0.0001).
The rate of total complications for treatment of DS and IS in this series was 9.2%. The total percentage of patients with complications was 7.9%. On univariate analysis, the complication rate was significantly higher in patients with high-grade spondylolisthesis, a diagnosis of DS, and in older patients. Surgical approach and history of previous surgery were not significantly correlated with increased complication rates. On multivariate analysis, only the grade of spondylolisthesis was significantly associated with the occurrence of complications.
这是一项对 10242 例退行性脊柱滑脱（DS）和峡部裂性脊柱滑脱（IS）患者的回顾性研究，资料来源于脊柱侧凸研究协会（SRS）的发病率和死亡率（M&M）索引。本数据库用于评估并发症发生率，并确定与并发症发生率增加相关的因素。
检索 SRS M&M 数据库，确定 2004 年至 2007 年期间治疗的 DS 和 IS 病例。根据年龄、手术入路、脊柱滑脱类型/分级和既往手术史确定并分析并发症。年龄分为>65 岁和≤65 岁两个亚组。手术入路分为以下亚组：单纯减压、前路、前路/后路、后路不固定、后路固定和椎间融合。脊柱滑脱分级分为低级别（Meyerding I 和 II 级）和高级别（Meyerding III、IV 和 V 级）。进行单变量和多变量分析。
在报告的 10242 例 DS 和 IS 病例中，813 例（7.9%）患者发生 945 例并发症（9.2%）。最常见的并发症是硬脊膜撕裂、伤口感染、植入物并发症和神经并发症（0.7%-2.1%）。死亡率为 0.1%。与 IS（6.6%）相比，DS 的并发症发生率（8.5%）显著更高（p=0.002）。高级别脊柱滑脱与更高的并发症发生率密切相关（22.9%比 8.3%，p<0.0001）。>65 岁年龄与更高的并发症发生率显著相关（p=0.02）。既往手术史和手术入路与更高的并发症发生率无显著相关性。多变量分析显示，只有脊柱滑脱分级（低 vs 高）是与并发症发生相关的最佳因素模型中的最后一个因素（p<0.0001）。
本研究系列中治疗 DS 和 IS 的总并发症发生率为 9.2%。发生并发症的患者总数为 7.9%。单变量分析显示，高级别脊柱滑脱、DS 诊断和老年患者的并发症发生率显著更高。手术入路和既往手术史与并发症发生率无显著相关性。多变量分析显示，只有脊柱滑脱分级与并发症的发生显著相关。
