Zakaria Hesham Mostafa, Schultz Lonni, Mossa-Basha Feras, Griffith Brent, Chang Victor
Departments of 1 Neurosurgery.
Public Health Sciences, and.
Neurosurg Focus. 2015 Oct;39(4):E5. doi: 10.3171/2015.7.FOCUS15257.
OBJECT Improved objective assessments of perioperative risk after spine surgery are necessary to decrease postoperative morbidity and mortality rates. Morphometric analysis has proven utility in predicting postoperative morbidity and mortality in surgical disciplines. The aim of the present study was to evaluate whether morphometrics can be applied to the cases of patients undergoing lumbar spine surgery. METHODS The authors performed a retrospective review of the perioperative course of 395 patients who underwent lumbar surgery at their institution from 2013 to 2014. Preoperative risk factors such as age, diabetes, smoking, coronary artery disease, and body mass index (BMI) were recorded. Preoperative MRI was used to measure the psoas muscle area at the L-4 vertebra and paraspinal muscle area at the T-12 vertebra. Primary outcomes included unplanned return to the operating room, 30- and 90-day readmissions, surgical site infection, wound dehiscence, new neurological deficit, deep vein thrombosis, pulmonary embolism, myocardial infarction, urinary tract infection, urinary retention, hospital-acquired pneumonia, stroke, and prolonged stay in the intensive care unit. RESULTS The overall rate of adverse events was 30%, the most common event being urinary retention (12%). Greater age (p = 0.015) and tobacco usage (p = 0.026) were both significantly associated with complications for all patients, while diabetes, coronary artery disease, and high BMI were not. No surgery-related characteristics were associated with postoperative morbidity, including whether surgery required instrumentation, whether it was a revision, or the number of vertebral levels treated. Using multivariate regression analysis, male and female patients with the lowest psoas tertile had an OR of 1.70 (95% CI 1.04-2.79, p = 0.035) for having postoperative complications. Male patients in the lowest psoas tertile had an OR of 2.42 (95% CI 1.17-5.01, p = 0.016) for having a postoperative complication. The paraspinal muscle groups did not provide any significant data for postoperative morbidity, even after multivariate analysis. CONCLUSIONS The morphometric measurement of psoas muscle size may be a sensitive predictive tool compared with other risk factors for perioperative morbidity in male patients undergoing lumbar surgery.
目的 为降低脊柱手术后的术后发病率和死亡率，有必要对脊柱手术的围手术期风险进行更完善的客观评估。形态测量分析已被证明在预测外科手术学科的术后发病率和死亡率方面具有实用性。本研究的目的是评估形态测量学是否可应用于接受腰椎手术的患者。方法 作者对2013年至2014年在其机构接受腰椎手术的395例患者的围手术期过程进行了回顾性研究。记录术前危险因素，如年龄、糖尿病、吸烟、冠状动脉疾病和体重指数（BMI）。术前MRI用于测量L4椎体水平的腰大肌面积和T12椎体水平的椎旁肌面积。主要结局包括非计划重返手术室、30天和90天再入院、手术部位感染、伤口裂开、新的神经功能缺损、深静脉血栓形成、肺栓塞、心肌梗死、尿路感染、尿潴留、医院获得性肺炎、中风以及在重症监护病房的延长住院时间。结果 不良事件的总体发生率为30%，最常见的事件是尿潴留（12%）。在所有患者中，年龄较大（p = 0.015）和吸烟（p = 0.026）均与并发症显著相关，而糖尿病、冠状动脉疾病和高BMI则不然。没有手术相关特征与术后发病率相关，包括手术是否需要内固定、是否为翻修手术或治疗的椎体节段数。使用多因素回归分析，腰大肌三分位数最低的男性和女性患者发生术后并发症的OR为1.70（95%CI 1.04 - 2.79，p = 0.035）。腰大肌三分位数最低的男性患者发生术后并发症的OR为2.42（95%CI 1.17 - 5.01，p = 0.016）。即使经过多因素分析，椎旁肌群也未提供任何关于术后发病率的显著数据。结论 与其他围手术期发病风险因素相比，腰大肌大小的形态测量可能是接受腰椎手术男性患者围手术期发病的敏感预测工具。
