Shriners Hospitals for Children-Philadelphia, Pennsylvania.
Baylor College of Medicine, Houston, Texas; and.
Neurosurg Focus. 2017 Oct;43(4):E10. doi: 10.3171/2017.7.FOCUS17384.
OBJECTIVE Postoperative complications are one of the most significant concerns in surgeries of the spine, especially in higher-risk cases such as neuromuscular scoliosis. Neuromuscular scoliosis is a classification of multiple diseases affecting the neuromotor system or musculature of patients leading to severe degrees of spinal deformation, disability, and comorbidity, all likely contributing to higher rates of postoperative complications. The objective of this study was to evaluate deformity correction of patients with neuromuscular scoliosis over a 12-year period (2004-2015) by looking at changes in postsurgical complications and management. METHODS The authors queried the Scoliosis Research Society (SRS) Morbidity and Mortality (M&M) database for neuromuscular scoliosis cases from 2004 to 2015. The SRS M&M database is an international database with thousands of self-reported cases by fellowship-trained surgeons. The database has previously been validated, but reorganization in 2008 created less-robust data sets from 2008 to 2011. Consequently, the majority of analysis in this report was performed using cohorts that bookend the 12-year period (2004-2007 and 2012-2015). Of the 312 individual fields recorded per patient, demographic analysis was completed for age, sex, diagnosis, and preoperative curvature. Analysis of complications included infection, bleeding, mortality, respiratory, neurological deficit, and management practices. RESULTS From 2004 to 2015, a total of 29,019 cases of neuromuscular scoliosis were reported with 1385 complications, equating to a 6.3% complication rate when excluding the less-robust data from 2008 to 2011. This study shows a 3.5-fold decrease in overall complication rates from 2004 to 2015. A closer look at complications shows a significant decrease in wound infections (superficial and deep), respiratory complications, and implant-associated complications. The overall complication rate decreased by approximately 10% from 2004-2007 to 2012-2015. CONCLUSIONS This study demonstrates a substantial decrease in complication rates from 2004 to 2015 for patients with neuromuscular scoliosis undergoing spine surgery. Decreases in specific complications, such as surgical site infection, allow us to gauge our progress while observing how trends in management affect outcomes. Further study is needed to validate this report, but these results are encouraging, helping to reinforce efforts toward continual improvement in patient care.
目的
术后并发症是脊柱手术中最令人关注的问题之一，尤其是在神经肌肉性脊柱侧凸等高危病例中。神经肌肉性脊柱侧凸是一种多种疾病的分类，影响患者的神经运动系统或肌肉，导致严重程度的脊柱变形、残疾和合并症，所有这些都可能导致更高的术后并发症发生率。本研究的目的是通过观察术后并发症和处理方式的变化，评估神经肌肉性脊柱侧凸患者在 12 年期间（2004-2015 年）的畸形矫正情况。
方法
作者查询了 Scoliosis Research Society（SRS）畸形与死亡率（M&M）数据库中 2004 年至 2015 年的神经肌肉性脊柱侧凸病例。SRS M&M 数据库是一个国际数据库，由 Fellowship 培训的外科医生报告了数千例病例。该数据库此前已得到验证，但 2008 年的重组导致 2008 年至 2011 年的数据集不够稳健。因此，本报告的大部分分析使用跨越 12 年的队列进行（2004-2007 年和 2012-2015 年）。对每位患者记录的 312 个单独字段进行了分析，完成了年龄、性别、诊断和术前曲率的人口统计学分析。并发症分析包括感染、出血、死亡率、呼吸、神经功能缺损和管理实践。
结果
2004 年至 2015 年，共报告了 29019 例神经肌肉性脊柱侧凸病例，其中 1385 例发生并发症，当排除 2008 年至 2011 年的数据不稳健后，并发症发生率为 6.3%。本研究显示，2004 年至 2015 年，总体并发症发生率下降了 3.5 倍。对并发症的进一步观察表明，伤口感染（浅表和深部）、呼吸并发症和植入物相关并发症显著减少。2004-2007 年至 2012-2015 年，总体并发症发生率下降了约 10%。
结论
本研究表明，神经肌肉性脊柱侧凸患者脊柱手术后的并发症发生率从 2004 年至 2015 年大幅下降。特定并发症（如手术部位感染）的减少使我们能够衡量我们的进展，同时观察管理趋势如何影响结果。需要进一步的研究来验证本报告，但这些结果令人鼓舞，有助于加强持续改善患者护理的努力。
