Segura-Trepichio Manuel, Candela-Zaplana David, Montoza-Nuñez José Manuel, Martin-Benlloch Antonio, Nolasco Andreu
Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitario del Vinalopó, Alicante, Spain.
Department of Orthopedic Surgery, Vinalopó University Hospital, Elx/ Elche, 03203 Alicante, Spain.
Patient Saf Surg. 2017 Nov 23;11:26. doi: 10.1186/s13037-017-0141-1. eCollection 2017.
The number of lumbar spine surgeries has been increasing during the last 20 years, which also leads to an increase in hospital costs and complications related to surgery. Therefore, there is a greater concern about the costs and safety of the techniques and implants used.
Patients (aged from 18 to 50 years) presenting with lumbago /sciatica (ICD-10-CM M54.3, M54.4) due to lumbar disc herniation lasting more than 12 weeks, were included. Patients with disc herniation larger than size-2 or size-3 according to the MSU Classification were eligible for participation. Intervention was divided in two groups. In Group 1, patients underwent microdiscectomy and Interspinous Dynamic Stabilization System (IDSS). Meanwhile, in Group 2, patients received discectomy and posterior lumbar interbody fusion (PLIF). The primary outcome measure was the length of stay and costs during hospital admission. We also evaluated several other outcome parameters, including 90- day readmission rate, 90-day complication rate, and re-operations rate. The study was an observational prospective cohort study carried out from January 2015 to August 2016 in which two surgical techniques were compared. Our hypothesis was that a less aggressive procedure, such as discectomy and DSS, will decrease the length of stay and costs, and that it will also reduce the rate of complications with respect to PLIF.
A total of 67 patients (mean age 39.8 ± 8.4 years) were included. Patients in the PLIF group had a length of stay increase of 109% (4.52 ± 1.76 days vs 2.16 ± 1.18 days < 0.001) and an in-hospital cost increase of 71% (1821.97 ± 460.41€ vs. 1066.20 ± 284.34€ p < 0.001). The reduction of one day of stay is equivalent to a reduction of total in-hospital costs of 12.5%. Patients in the IDSS cohort had no significant differences regarding PLIF cohort in the 90-day readmission rate (12.9% vs 11.1% € > 0.999, respectively), 90-day re-operation rate (12.9% vs 11.1% € p > 0.999) and 90-day complication rates (35.5% vs 52.8% € > 0.156). Dural tear and urinary tract infection rates were higher in the PLIF cohort (13.9% vs 3.2%. = 0.205 and 11.1% vs 0% = 0.118, respectively). Implant related complications were the most frequent in both IDSS and PLIF groups (32.3% vs 38.9% = 0.572).
Patients who underwent IDSS had a significant decrease of the length of stay and costs in relation to PLIF group. No significant differences were found in 90-day readmission and reintervention rates for both groups. Although differences were not significant, dural tear and urinary tract infection rates were lower in the interspinous group. IDSS or PLIF after discectomy, did not protect against subsequent 90-day re-operation or readmission compared to discectomy alone.
在过去20年中，腰椎手术的数量一直在增加，这也导致了与手术相关的医院成本和并发症的增加。因此，人们更加关注所使用技术和植入物的成本和安全性。
纳入因腰椎间盘突出症导致腰痛/坐骨神经痛（ICD-10-CM M54.3、M54.4）且持续时间超过12周的患者（年龄在18至50岁之间）。根据MSU分类，椎间盘突出大于2级或3级的患者符合参与条件。干预分为两组。在第1组中，患者接受显微椎间盘切除术和棘突间动态稳定系统（IDSS）。同时，在第2组中，患者接受椎间盘切除术和后路腰椎椎间融合术（PLIF）。主要结局指标是住院时间和住院期间的费用。我们还评估了其他几个结局参数，包括90天再入院率、90天并发症发生率和再次手术率。该研究是一项于2015年1月至2016年8月进行的观察性前瞻性队列研究，比较了两种手术技术。我们的假设是，一种侵入性较小的手术，如椎间盘切除术和DSS，将缩短住院时间和降低成本，并且相对于PLIF，它还将降低并发症发生率。
共纳入67例患者（平均年龄39.8±8.4岁）。PLIF组患者的住院时间增加了109%（4.52±1.76天对2.16±1.18天，<0.001），住院费用增加了71%（1821.97±460.41欧元对1066.20±284.34欧元，p<0.001）。住院时间减少一天相当于住院总费用降低12.5%。IDSS队列中的患者在90天再入院率（分别为12.9%对11.1%，>0.999）、90天再次手术率（12.9%对11.1%，p>0.999）和90天并发症发生率（35.5%对52.8%，>0.156）方面与PLIF队列相比无显著差异。PLIF队列中的硬脊膜撕裂和尿路感染率更高（分别为13.9%对3.2%，=0.205和11.1%对0%，=0.118）。与植入物相关的并发症在IDSS组和PLIF组中最为常见（32.3%对38.9%，=0.572）。
与PLIF组相比，接受IDSS的患者住院时间和费用显著降低。两组在90天再入院率和再次干预率方面未发现显著差异。尽管差异不显著，但棘突间组的硬脊膜撕裂和尿路感染率较低。与单纯椎间盘切除术相比，椎间盘切除术后的IDSS或PLIF并不能预防随后的90天再次手术或再入院。
