Sulaiman Olawale A R, Garces Juanita, Mathkour Mansour, Scullen Tyler, Jones Robert B, Arrington Teresa, Bui Cuong J
Department of Neurosurgery, Ochsner Health System, New Orleans, Louisiana, USA.
Department of Neurosurgery, Ochsner Health System, New Orleans, Louisiana, USA; Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana, USA.
World Neurosurg. 2017 Mar;99:295-301. doi: 10.1016/j.wneu.2016.11.075. Epub 2016 Nov 25.
Standard open surgical management of thoracolumbar infection, trauma, and tumor is associated with significant morbidity. We compared perioperative and immediate postoperative morbidity of open and mini-open thoracolumbar corpectomy techniques including direct hospital costs.
We retrospectively reviewed medical records of all patients who underwent open or mini-open corpectomy. Demographics (age, sex, body mass index, primary diagnosis), operative data (length of surgery, estimated blood loss, blood transfusion), surgical level, preoperative and postoperative neurologic status (using American Spinal Injury Association Impairment Scale), immediate perioperative complications (within 30 days postoperatively), overall length of stay from admission, length of stay from surgery, and total direct hospital costs were tabulated and analyzed.
The study included 43 patients, 20 (46.51%) undergoing open corpectomy and 23 (53.48%) undergoing mini-open corpectomy. Clinical and statistically significant findings in favor of mini-open corpectomy included lower estimated blood loss (1305 mL vs. 560 mL, P = 0.0072), less blood transfusion (241 mL vs. 667 mL, P = 0.029), shorter overall length of stay (7.2 days vs. 12.2 days, P = 0.047), and shorter surgery time (376 minutes vs. 295 minutes, P = 0.035) as well as lower total direct hospital cost ($34,373 vs. $45,376, P = 0.044). There was no statistically significant difference in postoperative complications between the 2 groups (medical complications 5% vs. 4.3%, P = 0.891; surgical complications 5% vs. 8.69%, P = 0.534).
Mini-open TL corpectomy is a safe, cost-effective, clinically effective, and less morbid alternative to standard open thoracotomy surgical techniques.
胸腰椎感染、创伤和肿瘤的标准开放手术治疗会导致显著的发病率。我们比较了开放和微创胸腰椎椎体次全切除术的围手术期及术后早期发病率,包括直接住院费用。
我们回顾性分析了所有接受开放或微创椎体次全切除术患者的病历。记录并分析了人口统计学资料(年龄、性别、体重指数、主要诊断)、手术数据(手术时长、估计失血量、输血情况)、手术节段、术前及术后神经功能状态(采用美国脊髓损伤协会损伤分级)、围手术期即刻并发症(术后30天内)、住院总时长、手术住院时长以及直接住院总费用。
该研究纳入43例患者,其中20例(46.51%)接受开放椎体次全切除术,23例(53.48%)接受微创椎体次全切除术。支持微创椎体次全切除术的临床及统计学显著发现包括较低的估计失血量(1305毫升对560毫升,P = 0.0072)、较少的输血量(241毫升对667毫升,P = 0.029)、较短的住院总时长(7.2天对12.2天,P = 0.047)、较短的手术时间(376分钟对295分钟,P = 0.035)以及较低的直接住院总费用(34373美元对45376美元,P = 0.044)。两组术后并发症无统计学显著差异(内科并发症5%对4.3%,P = 0.891;外科并发症5%对8.69%,P = 0.534)。
微创胸腰椎椎体次全切除术是一种安全、经济有效、临床效果良好且发病率较低的标准开放手术技术替代方案。