Polyclinique du Parc, Toulouse, France.
Spine (Phila Pa 1976). 2012 Apr 15;37(8):693-700. doi: 10.1097/BRS.0b013e31822ff5c1.
A multicentric retrospective study on primary adult scoliosis patients operated on between 2002 and 2007. A 3-step statistical analysis was performed to describe the incidence of complications, the risk factors, and the reoperation risk with survival curves for the entire cohort.
To describe complication rate and risk factors as well as survival curves associated with adult primary scoliosis surgery in patients aged 50 years or older.
Adult deformity surgery is classically associated with a high rate of complications. The identification of risk factors for developing such complications is consequently of major interest as well as survival curves that can provide useful information on reoperation risks. Although many reports exist in the literature, the cohorts analyzed are often heterogeneous and the actual prevalence of complications varies widely. This study represents to our knowledge the largest series on adult patients aged 50 years or older operated for the first time for lumbar or thoracolumbar scoliosis and excluding every other possible diagnosis.
A retrospective review of prospectively collected data from 6 centers in France. A total of 306 primary lumbar adult or degenerative scoliosis patients older than 50 years undergoing surgery between 2002 and 2007 were included. Demographics, comorbidities, x-ray parameters, surgical data, and complications were analyzed. Statistical analysis was performed to obtain correlations and risk factors for developing complications. Reoperation risk was calculated with Kaplan-Meier survival curves.
A total of 306 patients aged 63 years (range, 50-83), with 83% women. Mean follow-up was 54 months. Mean Cumulative Illness Rating Scale score was 5 (range, 0-26). Main curve was 50° (range, 4-96) with apex between T12 and L2. Ten percent of patients had anterior surgery only, 18% had double anteroposterior approach, and 72% had posterior surgery only. Seventy-four percent (226 patients) had long fusions of 3 or more levels and 44% (134 patients) were fused to the sacrum. Forty percent (122 patients) had a decompression performed and 18% had an osteotomy. There were 175 complications for 119 patients (39%). No cases of death or blindness were reported. General complication rate was 13.7%, early infection occurred in 4% (12 patients), and late infection occurred in 1.2%. Neurological complications were present in 7% with 2 cases (0.6%) of late cord-level deficits and 12 reoperations (4%). Prevalence of mechanical complications was 24% (73 patients), with 58 patients (19%) needing a reoperation. Risk factors for mechanical or neurological complications were number of instrumented vertebra (P ≤ 0.01) fusion to the sacrum (P ≤ 0.001), pedicle subtraction osteotomy (PSO) (P = 0.01), and a high preoperative pelvic tilt of 26° or more (P ≤ 0.05). Kaplan-Meier survival curves showed reoperation risk of 44% at 70 months. Long fusion risk was 40% at 50 months and fusions to the sacrum reoperation risk was 48% at 49 months.
Overall complication rate was 39%, and 26% of the patients were reoperated for mechanical or neurological complications. Risk factors include number of instrumented vertebra, fusion to the sacrum, PSO, and preoperative pelvic tilt of 26° or more. There is a 44% risk of a new operation in the 6-year-period after the primary procedure.
一项多中心回顾性研究，研究对象为 2002 年至 2007 年间接受初次成人脊柱侧凸手术的成年患者。通过三步统计分析，描述并发症的发生率、危险因素以及通过生存曲线评估整个队列的再次手术风险。
描述年龄在 50 岁及以上的成人原发性脊柱侧凸手术患者的并发症发生率、危险因素以及与手术相关的生存曲线。
成人脊柱畸形手术通常与较高的并发症发生率相关。因此，识别发生这些并发症的危险因素以及提供有关再次手术风险的生存曲线非常重要。尽管文献中有很多报道，但分析的队列往往具有异质性，并发症的实际发生率差异很大。本研究是我们所知的关于首次接受腰椎或胸腰椎侧凸手术且排除其他任何可能诊断的 50 岁及以上成人患者的最大系列研究。
对法国 6 个中心前瞻性收集的数据进行回顾性分析。共纳入 306 例年龄在 50 岁以上、初次接受手术治疗的成人腰椎或退行性脊柱侧凸患者，手术时间为 2002 年至 2007 年。分析患者的人口统计学、合并症、影像学参数、手术数据和并发症。通过统计学分析获得发生并发症的相关性和危险因素。通过 Kaplan-Meier 生存曲线计算再次手术风险。
共纳入 306 例年龄为 63 岁（范围为 50-83 岁）的患者，其中 83%为女性。平均随访时间为 54 个月。平均累积疾病严重程度评分（Cumulative Illness Rating Scale）为 5 分（范围为 0-26 分）。主弯角度为 50°（范围为 4-96°），顶点位于 T12 和 L2 之间。10%的患者仅接受前路手术，18%的患者接受前后联合入路手术，72%的患者仅接受后路手术。74%（226 例）的患者进行了 3 个或以上节段的长融合，44%（134 例）的患者融合至骶骨。40%（122 例）的患者进行了减压手术，18%的患者进行了截骨术。119 例患者（39%）发生了 175 例并发症。无死亡或失明病例报告。总体并发症发生率为 13.7%，早期感染发生率为 4%（12 例），晚期感染发生率为 1.2%。神经并发症发生率为 7%，其中 2 例（0.6%）为晚期脊髓水平缺损，12 例患者（4%）需要再次手术。机械性并发症的发生率为 24%（73 例），其中 58 例（19%）需要再次手术。发生机械或神经并发症的危险因素包括：置钉节段数量（P≤0.01）、融合至骶骨（P≤0.001）、经椎弓根椎体截骨术（pedicle subtraction osteotomy，PSO）（P=0.01）和术前骨盆倾斜角≥26°（P≤0.05）。Kaplan-Meier 生存曲线显示，70 个月时再次手术风险为 44%。长融合的风险在 50 个月时为 40%，融合至骶骨的再次手术风险在 49 个月时为 48%。
总体并发症发生率为 39%，26%的患者因机械或神经并发症需要再次手术。危险因素包括置钉节段数量、融合至骶骨、PSO 和术前骨盆倾斜角≥26°。初次手术后 6 年内再次手术的风险为 44%。
