Ramirez L F, Thisted R
Department of Neurosurgery, University of Wisconsin, Madison.
Neurosurgery. 1989 Aug;25(2):226-30; discussion 230-1. doi: 10.1097/00006123-198908000-00012.
We determined the incidence of acute, major complications in a population of 28,395 patients who underwent lumbar laminectomy for discogenic radiculopathy in the United States in 1980. This population was drawn from a broad cross-section of community hospitals and represented 31% of all patients who underwent laminectomy that year for this condition. Our cohort excluded patients with a) operations exceeding two disc levels, b) fusion, c) previous lumbar laminectomy, or d) coexistent discitis, spondylosis, spinal stenosis, myelopathy, or arachnoiditis. The incidence of death was 5.9 per 10,000. The causes of death were septicemia, myocardial infarction, and pulmonary emobolus. The incidence of at least one major complication was 157 per 10,000. The incidences of specific complications were as follows: infection requiring intravenously administered antibiotics, 30.7; major neurological deficit, 29.8; pulmonary embolus, 10.7; and myocardial infarction, 5.6. We studied four additional categories of complication. Patients were counted only when a second operation was required to treat the complication. The categories and incidence per 10,000 were as follows: incisional hematoma, 8.7; cerebrospinal fluid fistula, 10.5; ventral perforation, 1.6; and retention of a foreign body, 0.7. Among the patients whose hospitalizations were otherwise normal, 6.7% received a blood transfusion; of the patients whose hospitalizations were complicated, 24% required transfusion. The demographic characteristics of transfusion. The demographic characteristics of patients with a normal hospitalization were tabulated separately from those whose hospitalizations were complicated. Neurosurgeons performed 60% of the operations, and orthopedic surgeons performed 40%. The speciality of the surgeon was not a factor in determining the risk involved in surgery. Spinal anesthesia was used in 7% of the cases, and no pattern of complications emerged that was uniquely related to that technique.
我们确定了1980年在美国因椎间盘源性神经根病接受腰椎椎板切除术的28395名患者中急性、严重并发症的发生率。该人群来自广泛的社区医院，占当年因该疾病接受椎板切除术所有患者的31%。我们的队列排除了以下患者：a)手术超过两个椎间盘节段；b)融合术；c)既往腰椎椎板切除术；d)并存椎间盘炎、脊椎关节强硬、椎管狭窄、脊髓病或蛛网膜炎。死亡率为每10000人中有5.9人。死亡原因是败血症、心肌梗死和肺栓塞。至少发生一种严重并发症的发生率为每10000人中有157人。具体并发症的发生率如下：需要静脉注射抗生素的感染为30.7；严重神经功能缺损为29.8；肺栓塞为10.7；心肌梗死为5.6。我们研究了另外四类并发症。仅在需要二次手术治疗并发症时才对患者进行计数。每10000人的类别和发生率如下：切口血肿为8.7；脑脊液瘘为10.5；腹侧穿孔为1.6；异物残留为0.7。在住院情况正常的患者中，6.7%接受了输血；在住院情况复杂的患者中，24%需要输血。输血患者的人口统计学特征。住院情况正常的患者的人口统计学特征与住院情况复杂的患者分别列表。60%的手术由神经外科医生进行，40%由骨科医生进行。外科医生的专业不是决定手术风险的因素。7%的病例使用了脊髓麻醉，未出现与该技术有独特关联的并发症模式。
