Suh Seung-Pyo, Jo Young-Hoon, Jeong Hae Won, Choi Won Rak, Kang Chang-Nam
Department of Orthopaedic Surgery, Sung-Ae Hospital, Seoul, Korea.
Department of Orthopaedic Surgery, Hanyang University College of Medicine, Seoul, Korea.
Asian Spine J. 2017 Jun;11(3):463-471. doi: 10.4184/asj.2017.11.3.463. Epub 2017 Jun 15.
Retrospective study.
We examined the clinical and radiological outcomes of patients who received revision surgery for pseudarthrosis or adjacent segment disease (ASD) following decompression and instrumented posterolateral fusion (PLF).
At present, information regarding the outcomes of revision surgery for complications such as pseudarthrosis and ASD following instrumented PLF is limited.
This study examined 60 patients who received PLF for degenerative lumbar spinal stenosis and subsequently developed pseudarthrosis or ASD leading to revision surgery. Subjects were divided into a group of 21 patients who received revision surgery for pseudarthrosis (Group P) and a group of 39 patients who received revision surgery for ASD (Group A). Clinical outcomes were evaluated using the visual analogue scales for back pain (VAS-BP) and leg pain (VAS-LP), the Korean Oswestry disability index (K-ODI), and each patient's subjective satisfaction. Radiological outcomes were evaluated from the extent of bone union, and complications in the two groups were compared.
VAS-LP at final follow-up was not statistically different between the two groups ( =0.353), although VAS-BP and K-ODI at final follow-up were significantly worse in Group P than in Group A (all <0.05), and only 52% of the patients in Group P felt that their overall well-being had improved following revision surgery. Fusion rates after the first revision surgery were 71% (15/21) in Group P and 95% (37/39) in Group A ( =0.018). The rate of reoperation was significantly higher in Group P (29%) than in Group A (5%) ( =0.021) due to complications.
Clinical and radiological outcomes were worse in patients who had received revision surgery for pseudarthrosis than in those who had revision surgery for ASD. Elderly patients should be carefully advised of the risks and benefits before planning revision surgery for pseudarthrosis.
回顾性研究。
我们研究了接受减压及后路器械融合术（PLF）后因假关节或相邻节段疾病（ASD）而接受翻修手术患者的临床及影像学结果。
目前，关于器械辅助PLF术后假关节和ASD等并发症翻修手术结果的信息有限。
本研究纳入60例因退变性腰椎管狭窄接受PLF手术，随后因假关节或ASD导致需翻修手术的患者。将受试者分为21例因假关节接受翻修手术的患者组（P组）和39例因ASD接受翻修手术的患者组（A组）。使用背部疼痛视觉模拟量表（VAS-BP）、腿部疼痛视觉模拟量表（VAS-LP）、韩国奥斯威斯功能障碍指数（K-ODI）及每位患者的主观满意度评估临床结果。从骨融合程度评估影像学结果，并比较两组的并发症情况。
末次随访时两组间VAS-LP无统计学差异（=0.353），尽管P组末次随访时VAS-BP和K-ODI显著差于A组（均<0.05），且P组仅52%的患者认为翻修手术后整体健康状况有所改善。首次翻修手术后P组融合率为71%（15/21），A组为95%（37/39）（=0.018）。因并发症导致P组再次手术率（29%）显著高于A组（5%）（=0.021）。
因假关节接受翻修手术患者的临床及影像学结果比因ASD接受翻修手术患者更差。在为老年患者计划假关节翻修手术前，应仔细告知其风险和益处。
