Purvis Taylor E, De la Garza Ramos Rafael, Sankey Eric W, Karikari Isaac O, Goodwin C Rory, Sciubba Daniel M
Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, USA.
J Clin Neurosci. 2018 Apr;50:83-87. doi: 10.1016/j.jocn.2018.01.061. Epub 2018 Feb 21.
Management of spine fractures among the elderly is complicated by preexisting comorbidities and increased risk of osseous nonunion. Whether operative treatment is superior for the management of thoracolumbar fractures in the aged is unknown. The purpose of this study was to investigate the rates of in-hospital medical complications after non-operative and operative treatment of thoracolumbar fractures in elderly patients. The Nationwide Inpatient Sample database from 2002 to 2011 was used to identify patients over 75 years of age with a principal discharge diagnosis of thoracolumbar fracture without spinal cord injury. Three treatment groups were compared: non-operative treatment, operative treatment, and minimally-invasive vertebroplasty/kyphoplasty (VP/KP). A total of 59,565 patients were identified; 46,962 treated non-operatively, 1,487 treated operatively, and 11,116 treated with VP/KP. Operative patients had the longest length of hospital stay (P < 0.001) and the highest injury severity scores (P < 0.001). The percentage of patients who developed at least one complication was highest in the operative group (16.3%), versus 8.7% in the non-operative and 8.1% in the VP/KP group (P < 0.001). Even after controlling for potential confounders such as injury severity score, surgical patients had significantly higher odds of complication occurrence (P < 0.001). Adjusted charges were highest for operative patients ($123,777 ± 135,997 vs. $27,116 ± 32,694 [non-operative] and $42,326 ± 31,984 [VP/KP]). Operative treatment for elderly patients has higher complication rates that need to be considered during preoperative patient counseling. Future research is necessary to elucidate the comparative rates of long-term complications and functional status outcomes for thoracolumbar fracture treatment among elderly patients.
老年脊柱骨折的治疗因并存疾病和骨不连风险增加而变得复杂。手术治疗在老年胸腰椎骨折管理中是否更具优势尚不清楚。本研究的目的是调查老年患者胸腰椎骨折非手术和手术治疗后的院内医疗并发症发生率。使用2002年至2011年的全国住院患者样本数据库来识别75岁以上主要出院诊断为无脊髓损伤的胸腰椎骨折患者。比较了三个治疗组：非手术治疗、手术治疗和微创椎体成形术/后凸成形术（VP/KP）。共识别出59,565例患者；46,962例接受非手术治疗，1,487例接受手术治疗，11,116例接受VP/KP治疗。手术患者的住院时间最长（P<0.001），损伤严重程度评分最高（P<0.001）。发生至少一种并发症的患者百分比在手术组中最高（16.3%），而非手术组为8.7%，VP/KP组为8.1%（P<0.001）。即使在控制了损伤严重程度评分等潜在混杂因素后，手术患者发生并发症的几率仍显著更高（P<0.001）。手术患者的调整费用最高（123,777美元±135,997美元，而非手术组为27,116美元±32,694美元，VP/KP组为42,326美元±31,984美元）。老年患者的手术治疗并发症发生率更高，在术前患者咨询时需要考虑这一点。有必要进行未来研究以阐明老年患者胸腰椎骨折治疗的长期并发症和功能状态结果的比较发生率。
