Alpert Hilary W, Farley Frances A, Caird Michelle S, Hensinger Robert N, Li Ying, Vanderhave Kelly L
Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI.
J Pediatr Orthop. 2014 Sep;34(6):613-7. doi: 10.1097/BPO.0000000000000145.
Although there is good evidence to support the removal of instrumentation for infection following posterior spine fusion, there are few studies that report outcomes following removal for late operative site pain. The purpose of this study was 3-fold: (1) to determine whether removal of instrumentation following posterior spinal fusion resolves preoperative pain, (2) to determine whether indolent infection not detected before removal of instrumentation is related to late operative site pain, and (3) to determine whether curve progression differs when spinal hardware is removed for infection versus late operative site pain.
A retrospective study of consecutive patients aged 10 to 21 years, who underwent removal of instrumentation after posterior spinal fusion over a 10-year-period was conducted. Patient demographics, preoperative and postoperative imaging results, laboratory studies, and operative findings were reviewed. All patients had a minimum 2-year follow-up. Statistical analysis was performed using 2-sample t test, bivariate analysis, and multivariate logistic regression models.
Seventy-five patients were included. Indications for removal of spinal instrumentation were pain (57%), infection (28%), hardware failure (8%), and prominent hardware (7%). The mean time from index procedure to hardware removal was 2.8 years. The average loss of curve correction following complete hardware removal was 23.1 degrees. Patients who underwent removal of hardware because of infection had bigger changes in their curves than those without infection (mean, 33.8 degrees vs. 18.8 degrees). Of the 43 patients with pain, only 40% reported relief of their symptoms following removal of hardware. Sixteen of the 43 patients were found to have indolent infection confirmed by positive intraoperative culture results.
Patients should be cautioned that hardware removal after posterior spinal fusion may not provide complete pain relief. Furthermore, there is risk for curve progression following removal of instrumentation, particularly in the setting of infection. Back pain may be an indicator of infection, and intraoperative cultures should be taken at the time of implant removal.
Level IV; retrospective case series.
尽管有充分证据支持在脊柱后路融合术后因感染而取出内固定装置，但很少有研究报道因术后晚期手术部位疼痛而取出内固定装置后的结果。本研究的目的有三个：（1）确定脊柱后路融合术后取出内固定装置是否能缓解术前疼痛；（2）确定在取出内固定装置前未检测到的隐匿性感染是否与术后晚期手术部位疼痛有关；（3）确定因感染与因术后晚期手术部位疼痛而取出脊柱内固定装置时，脊柱侧弯进展情况是否不同。
对10至21岁连续患者进行回顾性研究，这些患者在10年期间接受了脊柱后路融合术后内固定装置取出术。回顾了患者的人口统计学资料、术前和术后影像学结果、实验室检查及手术发现。所有患者均进行了至少2年的随访。采用双样本t检验、双变量分析和多变量逻辑回归模型进行统计分析。
共纳入75例患者。取出脊柱内固定装置的指征包括疼痛（57%）、感染（28%）、内固定失败（8%）和内固定物突出（7%）。从初次手术到取出内固定装置的平均时间为2.8年。完全取出内固定装置后，脊柱侧弯矫正角度平均丢失23.1度。因感染而取出内固定装置的患者脊柱侧弯变化比未感染患者更大（平均33.8度对18.8度）。在43例因疼痛而取出内固定装置的患者中，只有40%报告术后症状缓解。43例患者中有16例术中培养结果呈阳性，证实存在隐匿性感染。
应告知患者，脊柱后路融合术后取出内固定装置可能无法完全缓解疼痛。此外，取出内固定装置后存在脊柱侧弯进展的风险，尤其是在感染情况下。背痛可能是感染的一个指标，取出内植物时应进行术中培养。
IV级；回顾性病例系列研究。
