David Geffen School of Medicine at University of California, Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90095, USA.
Department of Orthopaedic Surgery, University of California, Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90095, USA.
Spine J. 2018 Dec;18(12):2181-2186. doi: 10.1016/j.spinee.2018.04.018. Epub 2018 Apr 27.
Lumbar spine surgeries require adequate exposure to visualize key structures and limited exposure can make surgery more technically difficult, thus increasing the potential for complications. Body mass index and body mass distribution have been shown to be associated with worse surgical outcomes.
This study aims to further previous investigations in elucidating the predictive nature of body mass distribution with peri- and postoperative complications in lumbar surgery.
STUDY DESIGN/SETTING: This is a retrospective study conducted at a single institution.
Two hundred eighty-five patients who underwent lumbar laminectomy, laminotomy, or posterior lumbar interbody fusion or transforaminal lumbar interbody fusion procedures between 2013 and 2016.
Magnetic resonance imaging (MRI) results and electronic medical records were reviewed for measurements and relevant complications.
Previously known risk factors were identified and MRI measurements of subcutaneous adipose depth (SAD) relative to spinous process height (SPH) were measured at the surgical site to generate the subcutaneous lumbar spine (SLS) index. This measurement was then analyzed in association with recorded surgical complications.
The SLS index was found to be a significant risk factor for total complications (0.292, p=.041), perioperative complications (0.202, p=.015), and need for revision surgery (0.285, p<.001). The SAD alone proved to be negatively associated with perioperative complications (-0.075, p=.034) and need for revision surgery (-0.104, p=.001), with no predictive association seen for total or postoperative complications. Linear regression revealed an SLS index of 3.43 as a threshold value associated with a higher risk of total complications, 5.8 for perioperative complications, and 3.81 for the need for revision surgeries.
Body mass distribution of the surgical site as indicated by SAD to SPH (SLS index) is significantly associated with increasing risk of postoperative and perioperative complications as well as increased likelihood for necessary revision surgery. This relationship was shown to be a more accurate indication of perioperative risk than previous standards of body mass index and SAD alone, and may allow spine surgeons to assess surgical risk when considering lumbar spine surgery using simple calculations from standard preoperative MRI results.
腰椎手术需要充分暴露以可视化关键结构，而有限的暴露会使手术更具技术性难度，从而增加并发症的风险。体重指数和身体质量分布已被证明与手术结果较差有关。
本研究旨在进一步探讨身体质量分布与腰椎手术后围手术期并发症的预测性质。
研究设计/地点：这是一项在单一机构进行的回顾性研究。
2013 年至 2016 年间，285 例接受腰椎板切除术、椎板切除术或后路腰椎椎间融合术或经椎间孔腰椎椎间融合术的患者。
回顾磁共振成像（MRI）结果和电子病历，以评估测量结果和相关并发症。
确定已知的危险因素，并在手术部位测量皮下脂肪深度（SAD）相对于棘突高度（SPH），以生成皮下腰椎（SLS）指数。然后分析该测量值与记录的手术并发症之间的关系。
SLS 指数是总并发症（0.292，p=.041）、围手术期并发症（0.202，p=.015）和需要翻修手术的显著危险因素（0.285，p<.001）。单独的 SAD 与围手术期并发症（-0.075，p=.034）和需要翻修手术（-0.104，p=.001）呈负相关，与总并发症或术后并发症无预测关联。线性回归显示，SLS 指数为 3.43 是总并发症风险较高的阈值，5.8 是围手术期并发症的阈值，3.81 是需要翻修手术的阈值。
手术部位的身体质量分布（由 SAD 到 SPH 表示）与术后和围手术期并发症的风险增加以及需要翻修手术的可能性显著相关。与之前的体重指数和 SAD 标准相比，这种关系是围手术期风险的更准确指示，并且当考虑使用腰椎手术时，脊柱外科医生可能会根据标准术前 MRI 结果进行简单计算来评估手术风险。
