Department of Orthopaedic Surgery, The Johns Hopkins University/Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, #A665, Baltimore, MD 21224-2780, USA.
J Bone Joint Surg Am. 2013 Aug 7;95(15):1413-9. doi: 10.2106/JBJS.L.00358.
Few studies have examined the postsurgical functional outcomes of adults with spinal deformities, and even fewer have focused on the functional results and complications among older adults who have undergone primary or revision surgery for spinal deformity. Our goal was to compare patient characteristics, surgical characteristics, duration of hospitalization, radiographic results, complications, and functional outcomes between adults forty years of age or older who had undergone primary surgery for spinal deformity and those who had undergone revision surgery for spinal deformity.
We retrospectively reviewed the cases of 167 consecutive patients forty years of age or older who had undergone surgery for spinal deformity performed by the senior author (K.M.K.) from January 2005 through June 2009 and who were followed for a minimum of two years. We divided the patients into two groups: primary surgery (fifty-nine patients) and revision surgery (108 patients). We compared the patient characteristics (number of levels arthrodesed, type of procedure, estimated blood loss, and total operative time), duration of hospitalization, radiographic results (preoperative, six-week postoperative, and most recent follow-up Cobb angle measurements for thoracic and lumbar curves, thoracic kyphosis, and lumbar lordosis), major and minor complications, and functional outcome scores (Scoliosis Research Society-22 Patient Questionnaire and Oswestry Disability Index).
The groups were comparable with regard to most parameters. However, the revision group had more patients with sagittal plane imbalance and more frequently required pedicle subtraction osteotomies (p < 0.01). Patients in the primary group required more correction in the coronal plane than did patients in the revision group, whereas patients in the revision group required more correction in the sagittal plane. We found no significant difference between the two groups in the rate of major complications or in the Scoliosis Research Society-22 Patient Questionnaire functional outcome scores. There were significant improvements in many functional outcome scores in both groups between the preoperative and early (six-week) postoperative periods and between the early postoperative period and the time of final follow-up.
Revision surgery for spinal deformity in adults, although technically challenging and considered to present a higher risk than primary surgery, was shown to have a complication rate and outcomes that were comparable with those of primary spinal deformity surgery in adults.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
鲜有研究调查过脊柱畸形成年患者的术后功能预后，关注过接受过原发性或脊柱畸形修正手术的老年患者的功能结果和并发症的研究就更少了。我们的目标是比较年龄在 40 岁或以上的原发性脊柱畸形手术患者和脊柱畸形修正手术患者的患者特征、手术特征、住院时间、影像学结果、并发症和功能预后。
我们回顾性分析了 2005 年 1 月至 2009 年 6 月期间，由资深作者（K.M.K.）为 167 例年龄在 40 岁或以上的脊柱畸形患者施行手术的连续病例，这些患者的随访时间至少为两年。我们将患者分为两组：原发性手术（59 例）和修正手术（108 例）。我们比较了患者特征（融合节段数、手术类型、估计失血量和总手术时间）、住院时间、影像学结果（术前、术后 6 周、最近随访时的胸椎和腰椎曲线、胸腰椎后凸、腰椎前凸 Cobb 角测量值）、主要和次要并发症以及功能预后评分（脊柱侧凸研究协会-22 患者问卷和 Oswestry 残疾指数）。
两组在大多数参数上具有可比性。然而，修正组中矢状面失衡的患者更多，更频繁地需要椎弓根切除截骨术（p < 0.01）。与修正组相比，原发性组患者在冠状面需要更多的矫正，而修正组患者在矢状面需要更多的矫正。我们发现两组之间主要并发症发生率或脊柱侧凸研究协会-22 患者问卷功能预后评分无显著差异。两组的许多功能预后评分在术前与早期（术后 6 周）和早期术后与最终随访之间均有显著改善。
尽管成人脊柱畸形修正手术技术上具有挑战性，被认为比原发性手术风险更高，但结果显示其并发症发生率和结果与成人原发性脊柱畸形手术相当。
治疗性 IV 级。有关证据水平的完整描述，请参见作者说明。
