Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri.
Neurosurgery. 2018 May 1;82(5):701-709. doi: 10.1093/neuros/nyx295.
Current surgical management guidelines for pediatric spondylolisthesis (PS) are reliant on data from single-center cohorts.
To analyze national trends and predictors of short-term outcomes in spinal fusion surgery for PS by performing a retrospective cross-sectional analysis of the Kids' Inpatient Database (KID).
The KID (sampled every 3 yr) was queried from 2003 to 2012 to identify all cases (age 5-17) of spinal fusion for PS (n = 2646). We analyzed trends in patient characteristics, surgical management, and short-term outcomes. Both univariate and multivariable analyses were utilized.
The 2646 spinal fusions for PS included posterior-only fusions (86.8%, PSF), anterior lumbar interbody fusions (4.8%, ALIF), and combined anterior and posterior fusions (8.4%, APLF) procedures. The utilization of APLF decreased over time (9.9%-6.4%, P = .023), whereas the number of total spinal fusions and the proportion of PSF and ALIF procedures have not changed significantly. Uptrends in Medicaid insured individuals (1.2%-18.9%), recombinant human bone morphogenetic protein-2 insertion (8.8%-16.6%), decompression (34.7%-42.8%), and mean inflation-adjusted hospital costs ($21 855-$32 085) were identified (all P < .001). In multivariable analysis, Medicaid status (odds ratio [OR] = 1.93, P = .004), teaching hospitals (OR = 1.94, P = .01), decompression (OR = 1.78, P = .004), and the APLF procedure (OR = 2.47, P = .001) increased the likelihood of complication occurrence (all P < .001).
The addition of decompression during fusion and the APLF procedure were associated with more in-hospital complications, though this may have been indicative of greater surgical complexity. The utilization of the APLF procedure has decreased significantly, while costs associated with the treatment of PS have increased over time.
目前针对儿童脊柱滑脱症（PS）的外科治疗指南依赖于单中心队列的数据。
通过对小儿住院数据库（KID）进行回顾性横断面分析，分析脊柱融合术治疗 PS 的短期结果的全国趋势和预测因素。
从 2003 年至 2012 年，KID（每 3 年抽样一次）被查询以确定所有接受脊柱融合术治疗 PS（年龄 5-17 岁）的病例（n=2646）。我们分析了患者特征、手术管理和短期结果的趋势。进行了单变量和多变量分析。
2646 例 PS 脊柱融合术包括单纯后路融合术（86.8%，PSF）、前路腰椎椎间融合术（4.8%，ALIF）和前路联合后路融合术（8.4%，APLF）。APLF 的使用率随时间呈下降趋势（9.9%-6.4%，P=0.023），而总脊柱融合术的数量以及 PSF 和 ALIF 手术的比例没有显著变化。医疗补助保险覆盖人数（1.2%-18.9%）、重组人骨形态发生蛋白-2 植入物（8.8%-16.6%）、减压（34.7%-42.8%）和平均通胀调整后的医院费用（$21855-$32085）呈上升趋势（均 P<0.001）。多变量分析显示，医疗补助状态（比值比[OR] =1.93，P=0.004）、教学医院（OR=1.94，P=0.01）、减压（OR=1.78，P=0.004）和 APLF 手术（OR=2.47，P=0.001）增加了并发症发生的可能性（均 P<0.001）。
融合过程中增加减压和 APLF 手术与更多的院内并发症相关，但这可能表明手术复杂性增加。APLF 手术的使用率显著下降，而治疗 PS 的相关成本随时间推移而增加。
