Poorman Gregory W, Zhou Peter L, Vasquez-Montes Dennis, Horn Samantha, Bortz Cole, Segreto Frank, Auerbach Joshua, Moon John Y, Tishelman Jared C, Gerling Michael C, Diebo Bassel G, De La Garza-Ramos Rafael, Paul Justin C, Passias Peter G
NYU Langone Orthopaedic Hospital, New York, NY, USA.
Bronx-Lebanon Hospital Center, New York, NY, USA.
J Spine Surg. 2018 Jun;4(2):203-210. doi: 10.21037/jss.2018.05.06.
This study aims to describe properties of adult spinal deformity (ASD) revisions relative to primary surgeries and determine clinical variables that can predict revision. ASD is a common pathology that can lead to decreased quality of life, pain, physical limitations, and dissatisfaction with self-image. Durability of interventions for deformity treatment is of paramount concern to surgeons, as revision rates remain high.
Patients undergoing thoracolumbar fusion, five or more levels, for scoliosis (primary diagnosis ICD-9 737.x) were identified on a state-wide database. Primary and revision (returning for re-fusion procedure) surgeries were compared based on demographic, hospital stay, and clinical characteristics. Differences between primary and revision surgeries, and predictors of primary surgeries requiring revision, utilized binary logistic regression controlling for age, comorbidity burden, and levels fused.
A total of 1,063 patients (average 7.4 levels fused, mean age: 47.6 years, 69.0% female) undergoing operative treatment for ASD were identified, of which 123 (average 7.1 levels fused, 11.6%, mean age 61.43, 80.5% female) had surgical revision. Primary surgeries were ~0.3 levels longer (P=0.013), used interbody ~11% more frequently (P=0.020), and used BMP ~12% less frequently (P=0.008). Revisions occurred 176.4 days after the primary on average. The most frequent causes of revisions were: 43.09% implant failure, 24.39% acquired kyphosis, and 14.63% enduring scoliosis. After controlling for age, comorbidities, and levels fused older, more comorbid, female, and white-race patients were more likely to be revised. Upon multivariate regression, after controlling for age and levels fused, overall complications remained non-different (OR: 0.8, 95% CI: 0.6-1.2). However, revision remained an independent predictor for infection (OR: 5.5, 95% CI: 2.8-10.5).
In a statewide database with individual patient follow up of up to 4 years 10% of ASD patients undergoing scoliosis correction required revision. Revision surgeries had higher infection incidence.
本研究旨在描述成人脊柱畸形（ASD）翻修手术相对于初次手术的特点，并确定可预测翻修的临床变量。ASD是一种常见病症，可导致生活质量下降、疼痛、身体功能受限以及对自我形象不满。由于翻修率居高不下，脊柱畸形治疗干预措施的持久性是外科医生最为关注的问题。
在一个全州范围的数据库中识别接受胸腰椎融合术（五个或更多节段）治疗脊柱侧弯（主要诊断ICD-9 737.x）的患者。根据人口统计学、住院时间和临床特征对初次手术和翻修手术（再次进行融合手术）进行比较。利用二元逻辑回归分析控制年龄、合并症负担和融合节段，分析初次手术与翻修手术之间的差异以及初次手术需要翻修的预测因素。
共识别出1063例接受ASD手术治疗的患者（平均融合7.4个节段，平均年龄47.6岁，69.0%为女性），其中123例（平均融合7.1个节段，占11.6%，平均年龄61.43岁，80.5%为女性）进行了手术翻修。初次手术的融合节段长约0.3个节段（P=0.013），椎间融合器使用频率高约11%（P=0.020），骨形态发生蛋白（BMP）使用频率低约12%（P=0.008）。翻修手术平均在初次手术后176.4天进行。最常见的翻修原因是：植入物失败占43.09%，获得性后凸畸形占24.39%，持续性脊柱侧弯占14.63%。在控制年龄、合并症和融合节段后，年龄较大、合并症较多、女性和白人患者更有可能接受翻修手术。多因素回归分析显示，在控制年龄和融合节段后，总体并发症无差异（比值比：0.8，95%置信区间：0.6-1.2）。然而，翻修手术仍然是感染的独立预测因素（比值比：5.5，95%置信区间：2.8-10.5）。
在一个对个体患者进行长达4年随访的全州范围数据库中，10%接受脊柱侧弯矫正的ASD患者需要进行翻修手术。翻修手术的感染发生率更高。
