Passias Peter G, Oh Cheongeun, Horn Samantha R, Kim Han Jo, Hamilton D Kojo, Sciubba Daniel M, Neuman Brian J, Buckland Aaron J, Poorman Gregory W, Segreto Frank A, Bortz Cole A, Brown Avery E, Protopsaltis Themistocles S, Klineberg Eric O, Ames Christopher, Smith Justin S, Lafage Virginie
Department of Orthopaedic Surgery, NYU School of Medicine/NYU Langone Orthopedic Hospital at NYU Langone Medical Center, New York, NY, USA.
Department of Orthopaedic Surgery, NYU School of Medicine/NYU Langone Orthopedic Hospital at NYU Langone Medical Center, New York, NY, USA.
J Clin Neurosci. 2019 Jan;59:155-161. doi: 10.1016/j.jocn.2018.10.111. Epub 2018 Nov 17.
We developed a predictive model to describe risk factors for complications in cervical deformity surgeries. Cervical deformity (CD) surgical patients are growing in number, but remain under-studied in the literature. CD was defined as at least one of the following: C2-C7 Cobb >10°, CL >10°, cSVA >4 cm, CBVA >25°. Patient demographics and clinical data were assessed as risk factors for medical/surgical complications using multivariate regression models. 123 patients underwent CD surgery (60.6 yrs, 60.8% F). The most common complications were neurologic (24.4%), dysphagia (13.0%), cardiopulmonary (11.4%), infection (9.7%). 51 (41.5%) of patients experienced a medical complication and 73 (59.3%) had a surgical complication. An overall complication was predicted with high accuracy (AUC = 0.79) by the following combinations of factors: higher baseline EQ5D pain and lower baseline EQ5D anxiety/depression scores, and higher cervical and global SVA. A medical complication can be predicted by male gender, baseline mJOA score, and cervical SVA (AUC = 0.770). A surgical complication can be predicted by higher estimated blood loss, lower anxiety scores, and larger global SVA (AUC = 0.739). 64.2% of patients undergoing cervical deformity correction sustained any complication. While the most reliable predictor of the occurrence of a complication involved a cluster of risk factors, a radiographic baseline sagittal parameter of cervical SVA was the strongest isolated predictor for complications across categories. Although these findings are specific to a cervical population with moderate to severe deformities, collectively they can be utilized for pre-operative risk assessment and patient education.
我们开发了一种预测模型来描述颈椎畸形手术并发症的风险因素。颈椎畸形（CD）手术患者数量在不断增加，但在文献中仍研究不足。CD被定义为以下至少一项：C2-C7 Cobb角>10°、颈椎后凸（CL）>10°、颈椎矢状面垂直轴（cSVA）>4 cm、颈椎矢状面平衡（CBVA）>25°。使用多变量回归模型将患者人口统计学和临床数据评估为医疗/手术并发症的风险因素。123例患者接受了CD手术（平均年龄60.6岁，女性占60.8%）。最常见的并发症是神经方面的（24.4%）、吞咽困难（13.0%）、心肺方面的（11.4%）、感染（9.7%）。51例（41.5%）患者出现医疗并发症，73例（59.3%）有手术并发症。通过以下因素组合可高精度预测总体并发症（曲线下面积[AUC]=0.79）：较高的基线EQ5D疼痛评分和较低的基线EQ5D焦虑/抑郁评分，以及较高的颈椎和整体SVA。男性性别、基线改良日本骨科学会（mJOA）评分和颈椎SVA可预测医疗并发症（AUC=0.770）。较高的估计失血量、较低的焦虑评分和较大的整体SVA可预测手术并发症（AUC=0.739）。64.2%接受颈椎畸形矫正的患者出现了任何并发症。虽然并发症发生的最可靠预测因素涉及一组风险因素，但颈椎SVA的影像学基线矢状面参数是各类并发症中最强的独立预测因素。尽管这些发现特定于患有中度至重度畸形的颈椎患者群体，但总体而言，它们可用于术前风险评估和患者教育。
