Bateman Dexter K, Millhouse Paul W, Shahi Niti, Kadam Abhijeet B, Maltenfort Mitchell G, Koerner John D, Vaccaro Alexander R
Department of Orthopaedic Surgery, Rothman Institute/Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA.
Department of Orthopaedic Surgery, Rothman Institute/Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA.
Spine J. 2015 May 1;15(5):1118-32. doi: 10.1016/j.spinee.2015.02.040. Epub 2015 Feb 26.
The anterior approach to the lumbar spine is increasingly used to accomplish various surgical procedures. However, the incidence and risk factors for complications associated with anterior lumbar spine surgery (ALS) have not been fully elucidated.
To identify and document types of complications and complication rates associated with ALS, determine risk factors for these events, and evaluate the effect of measures used to decrease complication rates.
Systematic review and meta-analysis.
A systematic review of the English-language literature was conducted for articles published between January 1992 and December 2013. A MEDLINE search was conducted to identify articles reporting complications associated with ALS. For each complication, the data were combined using a generalized linear mixed model with a binomial probability distribution and a random effect based on the study. Predictors used were the type of procedure (open, minimally invasive, or laparoscopic), the approach used (transperitoneal vs. retroperitoneal), use of recombinant bone morphogenetic protein-2, use of preoperative computed tomography angiography (CTA), and the utilization of an access surgeon. Open surgery was used as a reference category.
Seventy-six articles met final inclusion criteria and reported complication rates in 11,410 patients who underwent arthrodesis and/or arthroplasty via laparoscopic, mini-open, and open techniques. The overall complication rate was 14.1%, with intraoperative and postoperative complication rates of 9.1% and 5.2%, respectively. Only 3% of patients required reoperation or revision procedures. The most common complications reported were venous injury (3.2%), retrograde ejaculation (2.7%), neurologic injury (2%), prosthesis related (2%), postoperative ileus (1.4%), superficial infection (1%), and others (1.3%). Laparoscopic and transperitoneal procedures were associated with higher complication rates, whereas lower complication rates were observed in patients receiving mini-open techniques. Our analysis indicated that the use of recombinant bone morphogenetic protein-2 was associated with increased rates of retrograde ejaculation; however, there may be limitations in interpreting these data. Data regarding the use of preoperative CTA and an access surgeon were limited and demonstrated mixed benefit.
Overall complication rates with ALS are relatively low, with the most common complications occurring at a rate of 1% to 3%. Complication rates are related to surgical technique, approach, and implant characteristics. Further randomized controlled trials are needed to validate the use of preventative measures including CTA and the use of an access surgeon.
腰椎前路越来越多地用于完成各种外科手术。然而，腰椎前路手术（ALS）相关并发症的发生率和危险因素尚未完全阐明。
识别并记录与ALS相关的并发症类型和并发症发生率，确定这些事件的危险因素，并评估用于降低并发症发生率的措施的效果。
系统评价和荟萃分析。
对1992年1月至2013年12月发表的英文文献进行系统评价。通过医学文献数据库检索来识别报告与ALS相关并发症的文章。对于每种并发症，使用广义线性混合模型并结合二项式概率分布和基于研究的随机效应来合并数据。使用的预测因素包括手术类型（开放手术、微创手术或腹腔镜手术）、手术入路（经腹 vs 腹膜后）、重组骨形态发生蛋白-2的使用、术前计算机断层血管造影（CTA）的使用以及是否有辅助手术医生。开放手术作为参考类别。
76篇文章符合最终纳入标准，报告了11410例通过腹腔镜、小切口开放和开放技术进行关节融合术和/或关节置换术患者的并发症发生率。总体并发症发生率为14.1%，术中及术后并发症发生率分别为9.1%和5.2%。仅3%的患者需要再次手术或翻修手术。报告的最常见并发症为静脉损伤（3.2%）、逆行射精（2.7%）、神经损伤（2%）、假体相关（2%）、术后肠梗阻（1.4%）、浅表感染（1%）和其他（1.3%）。腹腔镜手术和经腹手术的并发症发生率较高，而小切口开放技术患者的并发症发生率较低。我们的分析表明，重组骨形态发生蛋白-2的使用与逆行射精发生率增加有关；然而，在解释这些数据时可能存在局限性。关于术前CTA使用和辅助手术医生的数据有限，且显示出利弊不一。
ALS的总体并发症发生率相对较低，最常见并发症的发生率为1%至3%。并发症发生率与手术技术、手术入路和植入物特性有关。需要进一步的随机对照试验来验证包括CTA和辅助手术医生使用等预防措施的有效性。
