Department of Orthopaedics and Traumatology, Central Hospital of Central Finland, Jyväskylä, Finland.
Unit of Primary Health Care, Kuopio University Hospital, Kuopio, Finland.
Scand J Surg. 2019 Dec;108(4):343-351. doi: 10.1177/1457496918812201. Epub 2018 Nov 19.
Adult spinal deformity surgery has increased with the aging population and modern surgical approaches, although it has high complication and reoperation rates. The permanence of radiographic correction, mechanical complications, predictive factors for poor patient-reported outcomes, and patient satisfaction were analyzed.
A total of 79 adult patients were retrospectively analyzed at baseline and 1-9 years after adult spinal deformity correction between 2007 and 2016. Patient-reported outcomes (Oswestry Disability Index, visual analog scale, and Scoliosis Research Society-30 scores), changes in radiographic alignment, indications for reoperation, predictors of poor outcomes according to the Oswestry Disability Index and Scoliosis Research Society-30 scores, and patient satisfaction with management were studied.
Oswestry Disability Index and visual analog scale scores (p = 0.001), radiographic correction of thoracic kyphosis, lumbar lordosis, and pelvic retroversion (p ⩽ 0.001) and sagittal vertical axis (p = 0.043) were significantly better at 4-5 years of follow-up than at baseline. The risk for the first reoperation owing to mechanical failure of instrumentation or bone was highest within the first year, at 13.9% (95% confidence interval = 8.0%-23.7%), and 29.8% (95% confidence interval = 19.4%-43.9%) at the 5-year follow-up. Oswestry Disability Index and Scoliosis Research Society-30 total scores had a good correlation (r = -0.78; 95% CI = -0.86 to -0.68; p < 0.001). Satisfaction with management was correlated with patient-reported outcomes. Male sex and depression (p = 0.021 and 0.018, respectively) predicted poor outcomes according to the Oswestry Disability Index and/or Scoliosis Research Society-30 score.
The achieved significant radiographic correction was maintained 5 years postoperatively. Despite reoperations, patient satisfaction and clinical outcomes were good. Depression and male sex predicted poor clinical outcomes.
随着人口老龄化和现代手术方法的发展，成人脊柱畸形手术有所增加，但此类手术并发症和再次手术率较高。本研究分析了影像学矫正的持久性、机械并发症、不良患者报告结局的预测因素以及患者满意度。
回顾性分析了 2007 年至 2016 年期间接受成人脊柱畸形矫正的 79 例成年患者，基线时及术后 1-9 年时记录患者报告的结局（Oswestry 功能障碍指数、视觉模拟评分和 Scoliosis Research Society-30 评分）、影像学矫正参数、翻修手术指征、根据 Oswestry 功能障碍指数和 Scoliosis Research Society-30 评分预测不良结局的因素以及患者对治疗的满意度。
Oswestry 功能障碍指数和视觉模拟评分（p=0.001）、胸腰椎后凸、腰椎前凸和骨盆后倾的影像学矫正（p ⩽ 0.001）以及矢状垂直轴（p=0.043）在术后 4-5 年随访时明显优于基线。因器械或骨的机械故障而首次翻修的风险在术后 1 年内最高，为 13.9%（95%置信区间为 8.0%-23.7%），术后 5 年时为 29.8%（95%置信区间为 19.4%-43.9%）。Oswestry 功能障碍指数和 Scoliosis Research Society-30 总分之间具有良好的相关性（r=-0.78；95%置信区间为-0.86 至 -0.68；p<0.001）。患者满意度与患者报告的结局相关。根据 Oswestry 功能障碍指数和/或 Scoliosis Research Society-30 评分，男性和抑郁（分别为 p=0.021 和 0.018）是预测不良结局的因素。
术后 5 年时影像学矫正仍保持显著效果。尽管进行了再次手术，但患者满意度和临床结局仍良好。抑郁和男性是预测临床结局不良的因素。
