Abt Nicholas B, De la Garza-Ramos Rafael, Olorundare Israel O, McCutcheon Brandon A, Bydon Ali, Fogelson Jeremy, Nassr Ahmad, Bydon Mohamad
Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Spinal Column Biomechanics and Surgical Outcomes Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Spinal Column Biomechanics and Surgical Outcomes Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
Clin Neurol Neurosurg. 2016 Apr;143:126-31. doi: 10.1016/j.clineuro.2016.02.024. Epub 2016 Feb 23.
Anterior lumbar interbody fusion (ALIF) is a common procedure used to treat various lumbar degenerative pathologies. The purpose of this study is to describe 30-day postoperative outcomes following ALIF on a national scale.
The American College of Surgeons National Surgery Quality Improvement Program (ACS NSQIP) was searched for ALIF patients between 2005 and 2011. The top preoperative diagnoses were determined using ICD-9 codes. All available 30-day complications were grouped as overall composite morbidity and were compared between preoperative diagnosis groups by univariable and multivariable analyses.
There were a total of 1352 ALIF patients. Overall, 6.73% of patients experienced a postoperative complication. Unplanned reoperations (2.48%), urinary tract infection (1.55%), superficial surgical site infection (1.41%), and sepsis (1.11%) were the most common morbidity events. The morbidity rates for each sub-group were: intervertebral disc degeneration (4.41%), spondylosis (6.72%), lumbosacral spinal stenosis(8.21%), and spondylolisthesis (8.41%). After extensive adjustment for patient characteristics and preoperative morbidities, multivariable analysis revealed spondylolisthesis (OR=3.29; 95% CI:1.04-10.46) and spinal stenosis (OR=3.76; 95% CI:1.33-10.63) to be associated with significantly higher overall morbidity odds when compared with lumbar disc degeneration. Lumbosacral spondylosis was associated with similar outcomes as degenerative disc disease (OR =1.70; 95% CI:0.48-6.06).
Diverse postoperative complications need to be managed following ALIF. Patients with spondylolisthesis and spinal stenosis may carry increased 30-day postoperative morbidity profiles in ALIF when compared to those with degenerative disc disease. Prospective studies are needed to better delineate the outcomes of ALIF procedures, particularly in the spondylolisthesis and spinal stenosis patient populations.
腰椎前路椎间融合术（ALIF）是治疗各种腰椎退行性病变的常用手术。本研究的目的是在全国范围内描述ALIF术后30天的结果。
检索美国外科医师学会国家外科质量改进计划（ACS NSQIP）中2005年至2011年的ALIF患者。使用ICD-9编码确定术前主要诊断。将所有可用的30天并发症归为总体综合发病率，并通过单变量和多变量分析在术前诊断组之间进行比较。
共有1352例ALIF患者。总体而言，6.73%的患者出现术后并发症。计划外再次手术（2.48%）、尿路感染（1.55%）、手术切口浅表感染（1.41%）和败血症（1.11%）是最常见的发病事件。各亚组的发病率分别为：椎间盘退变（4.41%）、脊柱关节病（6.72%）、腰骶部椎管狭窄（8.21%）和腰椎滑脱（8.41%）。在对患者特征和术前疾病进行广泛调整后，多变量分析显示，与腰椎间盘退变相比，腰椎滑脱（OR=3.29；95%CI：1.04-10.46）和椎管狭窄（OR=3.76；95%CI：1.33-10.63）与总体发病率显著较高相关。腰骶部脊柱关节病与椎间盘退变的结果相似（OR =1.70；95%CI：0.48-6.06）。
ALIF术后需要处理各种术后并发症。与椎间盘退变患者相比，腰椎滑脱和椎管狭窄患者在ALIF术后30天的发病率可能更高。需要进行前瞻性研究以更好地描述ALIF手术的结果，特别是在腰椎滑脱和椎管狭窄患者群体中。
