Departments of 1 Neurological Surgery and.
Orthopedic Surgery, University of California, San Francisco, California.
Neurosurg Focus. 2017 Dec;43(6):E8. doi: 10.3171/2017.8.FOCUS17460.
OBJECTIVE Adult spinal deformity (ASD) develops in the setting of asymmetrical arthritic degeneration, and can also be due to iatrogenic causes, such as prior surgery. Many patients who present with ASD have undergone prior spine surgery with instrumentation. Unfortunately, contemporary studies that evaluate the effect of prior surgery or instrumentation on perioperative outcomes, readmission rates, and need for reoperation are lacking. METHODS All ASD patients who underwent a 3-column osteotomy performed by the senior author at the authors' institution for correction of thoracolumbar spinal deformity between 2006 and 2016 were identified. The authors compared surgical outcomes between primary (first-time) and revision cases. Further subgroup analysis was conducted to investigate the effect of the number of prior surgeries (0, 1, 2, 3, 4, and 5 or more) and the presence of spinal instrumentation on outcomes. Multivariate analysis was used to adjust for relevant and significant confounders. RESULTS A total of 300 patients were included; 38.3% of patients were male. The overall perioperative complication rate was 24.7%, and the mean length of hospitalization was 8.2 days. The 90-day readmission rate was 9.0%, and the overall follow-up reoperation rate was 26.7%. There were no significant differences in complication rates (26.6% vs 24.0%, p = 0.645), length of hospitalization (8.7 vs 7.9 days, p = 0.229), readmission rates (11.4% vs 8.1%, p = 0.387), or reoperation rates (26.6% vs 26.7%, p = 0.984) between primary and revision cases. There was no significant difference in wound complications (infections/dehiscence) requiring reoperation (5.1% vs 6.3%, p = 0.683). Subgroup analysis conducted to evaluate the effect of the number of prior spinal surgeries or the presence of spinal instrumentation did not reveal significant differences for the aforementioned surgical outcomes. In adjusted multivariate analysis, there were no significant associations between history of prior surgery (number of prior surgeries and prior instrumentation) and all of the surgical outcomes of interest. CONCLUSIONS The findings from this study suggest that patients who have undergone prior spine surgery with or without instrumentation are not at increased risk for perioperative complications, need for readmission, or reoperation following 3-column osteotomy of the thoracolumbar spine.
成人脊柱畸形（ASD）是在不对称性关节炎退变的基础上发展起来的，也可能是医源性的，如先前的手术。许多出现 ASD 的患者都接受过先前的脊柱手术和器械治疗。不幸的是，目前缺乏评估先前手术或器械对围手术期结果、再入院率和再次手术需求的影响的研究。
本研究回顾性分析了 2006 年至 2016 年期间，作者所在机构的一位资深作者对胸腰椎脊柱畸形患者进行的 3 柱截骨术的所有 ASD 患者。作者比较了初次（首次）和翻修病例的手术结果。进一步的亚组分析旨在研究既往手术次数（0、1、2、3、4 次或更多次）和脊柱器械存在对结果的影响。多变量分析用于调整相关和显著的混杂因素。
共纳入 300 例患者，其中 38.3%为男性。围手术期并发症总体发生率为 24.7%，平均住院时间为 8.2 天。90 天再入院率为 9.0%，总随访再手术率为 26.7%。初次和翻修病例的并发症发生率（26.6%比 24.0%，p=0.645）、住院时间（8.7 比 7.9 天，p=0.229）、再入院率（11.4%比 8.1%，p=0.387）和再手术率（26.6%比 26.7%，p=0.984）均无显著差异。需要再次手术的伤口并发症（感染/裂开）发生率也无显著差异（5.1%比 6.3%，p=0.683）。对既往脊柱手术次数或脊柱器械存在情况进行的亚组分析，并未发现上述手术结果存在显著差异。在调整后的多变量分析中，既往手术史（既往手术次数和既往器械使用）与所有感兴趣的手术结果均无显著关联。
本研究结果表明，接受过脊柱手术（有或无器械治疗）的患者在接受胸腰椎 3 柱截骨术后，围手术期并发症、再入院和再次手术的风险并不增加。
