Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Trauma, Hand, and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Trauma, Orthopaedic, and Plastic Surgery, University Medical Center Goettingen, Goettingen, Germany.
Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
World Neurosurg. 2018 Jan;109:e739-e747. doi: 10.1016/j.wneu.2017.10.074. Epub 2017 Nov 13.
Posterior-anterior spondylodesis is often used to stabilize the spine in various pathologies. The anterior procedure is often performed via thoracoscopy. It is unclear whether the anterior procedure should be performed immediately after posterior instrumentation or after the patient has convalesced. This retrospective study compared perioperative safety and morbidity in 1-stage versus 2-stage posterior-anterior fusion surgery with a thoracoscopic anterior approach.
All consecutive patients who underwent surgery for posterior-anterior spinal stabilization from 2006 to 2013 were included. American Society of Anesthesiologists score, preoperative and postoperative laboratory values, operation duration, blood loss, intensive care unit stay, pain, postoperative hospital stay, perioperative complications, and preoperative and postoperative Eastern Cooperative Oncology Group and Frankel scores were assessed. A subset of the cohort was selected by propensity score matching to eliminate possible selection bias.
There were 247 patients who underwent 1-stage (n = 104) or 2-stage (n = 143) stabilization with thoracoscopic fusion. Spinal pathologies were fracture, malignancy, pyogenic spondylodiscitis, degenerative spinal disorders, and failed previous surgery. One-stage and 2-stage procedures were similar in terms of preoperative, surgical, and postoperative variables, including complication rates, except that the 1-stage procedure was associated with greater pain 2 days after surgery and shorter hospital stay. The propensity score-matched cohort of 64 pairs yielded similar results with only 1-stage patients showing elevated visual analog scale score on postoperative day 2 (3.8 vs. 2.4, P = 0.043).
One-stage stabilization was as safe as 2-stage stabilization and associated with shorter hospitalization. Greater pain after the 1-stage procedure, which resolved 30 days after surgery, reflects the fact that 2-stage patients already had pain relief when they underwent thoracoscopy.
后路-前路脊柱融合术常用于稳定各种病变的脊柱。前路手术通常通过胸腔镜进行。目前尚不清楚前路手术应在后路器械固定后立即进行，还是在患者康复后进行。本回顾性研究比较了 1 期与 2 期后路-前路融合术联合胸腔镜前路入路的围手术期安全性和发病率。
纳入 2006 年至 2013 年间接受后路-前路脊柱稳定手术的所有连续患者。评估美国麻醉医师协会评分、术前和术后实验室值、手术时间、失血量、重症监护病房停留时间、疼痛、术后住院时间、围手术期并发症、术前和术后东部合作肿瘤组和 Frankel 评分。通过倾向评分匹配选择队列的一部分，以消除可能的选择偏倚。
有 247 例患者接受了 1 期（n=104）或 2 期（n=143）的胸腔镜融合稳定手术。脊柱病变包括骨折、恶性肿瘤、化脓性脊椎炎、退行性脊柱疾病和先前手术失败。1 期和 2 期手术在术前、手术和术后变量方面相似，包括并发症发生率，只是 1 期手术在术后 2 天疼痛更严重，住院时间更短。64 对匹配倾向评分的患者得出了类似的结果，只有 1 期患者在术后第 2 天视觉模拟评分更高（3.8 比 2.4，P=0.043）。
1 期稳定与 2 期稳定同样安全，并与较短的住院时间相关。1 期手术后疼痛更大，在手术后 30 天缓解，这反映了 2 期患者在接受胸腔镜手术时已经缓解了疼痛的事实。
