Department of Neurosurgery, University of Virginia, Charlottesville, Virginia.
Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York.
Neurosurgery. 2018 Dec 1;83(6):1277-1285. doi: 10.1093/neuros/nyx605.
Surgical treatments for adult cervical spinal deformity (ACSD) are often complex and have high complication rates.
To assess all-cause mortality following ACSD surgery.
ACSD patients presenting for surgical treatment were identified from a prospectively collected multicenter database. Clinical and surgical parameters and all-cause mortality were assessed.
Of 123 ACSD patients, 120 (98%) had complete baseline data (mean age, 60.6 yr). The mean number of comorbidities per patient was 1.80, and 80% had at least 1 comorbidity. Surgical approaches included anterior only (15.8%), posterior only (50.0%), and combined anterior/posterior (34.2%). The mean number of vertebral levels fused was 8.0 (standard deviation [SD] = 4.5), and 23.3% had a 3-column osteotomy. Death was reported for 11 (9.2%) patients at a mean of 1.1 yr (SD = 0.76 yr; range = 7 d to 2 yr). Mean follow-up for living patients was 1.2 yr (SD = 0.64 yr). Causes of death included myocardial infarction (n = 2), pneumonia/cardiopulmonary failure (n = 2), sepsis (n = 1), obstructive sleep apnea/narcotics (n = 1), subsequently diagnosed amyotrophic lateral sclerosis (n = 1), burn injury related to home supplemental oxygen (n = 1), and unknown (n = 3). Deceased patients did not significantly differ from alive patients based on demographic, clinical, or surgical parameters assessed, except for a higher major complication rate (excluding mortality; 63.6% vs 22.0%, P = .006).
All-cause mortality at a mean of 1.2 yr following surgery for ACSD was 9.2% in this prospective multicenter series. Causes of death were reflective of the overall high level of comorbidities. These findings may prove useful for treatment decision making and patient counseling in the context of the substantial impact of ACSD.
成人颈椎脊柱畸形（ACSD）的手术治疗往往较为复杂，且并发症发生率较高。
评估 ACSD 手术后的全因死亡率。
从一个前瞻性收集的多中心数据库中确定接受手术治疗的 ACSD 患者。评估临床和手术参数以及全因死亡率。
在 123 例 ACSD 患者中，120 例（98%）具有完整的基线数据（平均年龄 60.6 岁）。每位患者的平均合并症数量为 1.80，80%至少有 1 种合并症。手术入路包括前路（15.8%）、后路（50.0%）和前后路联合（34.2%）。平均融合的椎体节段数为 8.0（标准差[SD] 4.5），23.3%进行了 3 柱截骨。11 例（9.2%）患者在平均 1.1 年（SD 0.76 年；范围 7 天至 2 年）时报告死亡。存活患者的中位随访时间为 1.2 年（SD 0.64 年）。死亡原因包括心肌梗死（n=2）、肺炎/心肺衰竭（n=2）、脓毒症（n=1）、阻塞性睡眠呼吸暂停/麻醉药物（n=1）、随后诊断的肌萎缩侧索硬化症（n=1）、与家庭补充氧气相关的烧伤伤（n=1）和原因不明（n=3）。死亡患者与存活患者在评估的人口统计学、临床或手术参数方面没有显著差异，除了主要并发症发生率较高（不包括死亡率；63.6%比 22.0%，P=0.006）。
在这项前瞻性多中心研究中，ACS 手术后平均 1.2 年的全因死亡率为 9.2%。死亡原因反映了总体较高的合并症水平。这些发现可能有助于治疗决策和患者咨询，因为 ACSD 具有重大影响。
