Department of Orthopaedics, Mount Sinai School of Medicine, New York, NY, USA.
Spine (Phila Pa 1976). 2012 Mar 15;37(6):489-500. doi: 10.1097/BRS.0b013e3182217ab5.
Retrospective cohort comparative study.
To determine the prevalence of major complications, identify risk factors, and assess long-term clinical benefit after revision adult spinal deformity surgery.
No study has analyzed risk factors for major complications in long revision fusion surgery and whether or not occurrence of a major complication affects ultimate clinical outcome.
Analysis of consecutive adult patients who underwent multilevel revision surgery for spinal deformity with a minimum 2-year follow-up was performed. All complications were classified as either major or minor. Outcome analysis was conducted with the Scoliosis Research Society and Oswestry Disability Index scores.
A total of 166 patients (mean age = 53.8 years) were identified with a mean follow-up of 3.5 years (range: 2-7). Primary diagnoses included idiopathic/de novo scoliosis (107), degenerative (35), trauma (7), neuromuscular scoliosis (6), congenital deformity (5), ankylosing spondylitis (2), tumor (2), Scheuermann kyphosis (1), and rheumatoid arthritis (1). Most common secondary diagnoses that necessitated revision surgery were adjacent segment disease, fixed sagittal imbalance, and pseudarthrosis. Overall, 34.3% of patients developed major complications (19.3% perioperative; 18.7% follow-up). Associated risk factors for perioperative complications were patient- (age > 60 years, medical comorbidities, obesity) and surgery-related (pedicle subtraction osteotomy). Performance of a 3-column osteotomy and postoperative radiographic changes that suggested progressive loss of sagittal correction were recognized as risk factors for follow-up complications. Equivalent outcome scores were reported by patients preoperatively, but those experiencing follow-up complications reported lower scores at the final follow-up.
Overall, 34.4% of patients experienced major complications after long revision fusion surgery. Different risk factors were identified for perioperative versus follow-up complications. The occurrence of a follow-up, not but perioperative, major complication seemed to have a negative impact on ultimate clinical outcome.
回顾性队列比较研究。
确定主要并发症的发生率，确定危险因素，并评估成人脊柱畸形翻修手术后的长期临床获益。
尚无研究分析长节段翻修融合术中主要并发症的危险因素，以及主要并发症的发生是否会影响最终的临床结局。
对接受多节段脊柱畸形翻修手术的连续成年患者进行分析，随访时间至少为 2 年。所有并发症均分为主要并发症和次要并发症。采用脊柱侧凸研究协会（Scoliosis Research Society，SRS）和 Oswestry 残疾指数（Oswestry Disability Index，ODI）评分进行疗效分析。
共纳入 166 例患者（平均年龄为 53.8 岁），平均随访时间为 3.5 年（范围：2-7 年）。主要诊断包括特发性/新发脊柱侧凸（107 例）、退行性脊柱侧凸（35 例）、创伤（7 例）、神经肌肉型脊柱侧凸（6 例）、先天性脊柱畸形（5 例）、强直性脊柱炎（2 例）、肿瘤（2 例）、Scheuermann 后凸（1 例）和类风湿性关节炎（1 例）。最常见的需要翻修手术的继发性疾病包括邻近节段疾病、固定矢状面失衡和假关节形成。总体而言，34.3%的患者发生了主要并发症（围手术期 19.3%，随访期 18.7%）。围手术期并发症的相关危险因素包括患者相关因素（年龄>60 岁、合并内科疾病、肥胖）和手术相关因素（椎弓根截骨术）。行三柱截骨术和术后影像学显示矢状面矫正丢失进展被认为是随访期并发症的危险因素。患者术前报告的功能评分相同，但发生随访期并发症的患者在最终随访时的评分较低。
在长节段翻修融合术后，总体有 34.4%的患者发生了主要并发症。围手术期和随访期并发症的危险因素不同。随访期主要并发症的发生似乎对最终临床结局有负面影响，而非围手术期主要并发症。
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