Shillingford Jamal N, Laratta Joseph L, Sarpong Nana O, Alrabaa Rami G, Cerpa Meghan K, Lehman Ronald A, Lenke Lawrence G, Fischer Charla R
The Spine Hospital at New York Presbyterian, New York, NY, USA.
NYU Langone Orthopedic Hospital, New York, NY, USA.
J Spine Surg. 2019 Mar;5(1):110-115. doi: 10.21037/jss.2018.12.09.
Objective of this study is to evaluate demographics, risk factors, and incidence of instrumentation related complications (IRC) in spinal surgeries from 2009-2012. The Scoliosis Research Society (SRS) morbidity and mortality (M&M) database has tremendous value in orthopaedic surgery. SRS gathers surgeon-reported complications, including instrumentation failure, visual complications, neurological deficits, infections, and death. Limited literature exists on the incidence of perioperative instrumentation complications in deformity surgery. We utilized the SRS database to evaluate demographics, risk factors, and incidence of IRC in spinal surgeries from 2009-2012.
The SRS M&M database was queried for IRC in patients undergoing surgery for scoliosis, spondylolisthesis, and kyphosis from 2009-2012. Demographics, comorbidities, diagnoses, curve magnitude, and intraoperative characteristics were analyzed. Intraoperative characteristics included surgical approach, performance of fusion or osteotomy, operative times, blood loss, instrumentation used, and documented instrumentation complication.
A total of 167,972 patients were identified, including 311 IRC. The overall IRC rate was 0.19% (18.5 per 10,000 patients), which decreased significantly from 2009-2012 (0.37% 0.19%, P<0.001). The mean age of patients with IRC was 38.5±25.5 years. Most common comorbidities included hypertension (23.5%), pulmonary disease (13.5%), diabetes (10.6%), smoking (8.7%), and vascular disease (7.1%). IRC occurred in 206 (66.2%) patients with scoliosis, 58 (18.6%) with spondylolisthesis, and 45 (14.5%) with kyphosis. Compared to patients with spondylolisthesis, patients with kyphosis (0.27% 0.11%, P<0.001) and scoliosis (0.21% 0.11%, P<0.001), experienced significantly more IRC. IRC included implant failure (23.3%), migration (28.3%), and malpositioned implants (48.6%). New perioperative neurologic deficits were reported in 146 (46.9%) patients, and 84 (27%) of these implants were removed.
IRC occur in approximately 18.5 per 10,000 deformity patients, with a rate significantly higher in patients with kyphosis. The potentially avoidable occurrence of implant malpositioning represents nearly 50% of these complications. Closer attention to posterior bony anatomy, improved intraoperative imaging with utilization of navigation or robotic guidance may decrease these complications.
本研究的目的是评估2009年至2012年脊柱手术中患者的人口统计学特征、风险因素以及器械相关并发症（IRC）的发生率。脊柱侧弯研究学会（SRS）的发病率和死亡率（M&M）数据库在骨科手术中具有巨大价值。SRS收集外科医生报告的并发症，包括器械故障、视力并发症、神经功能缺损、感染和死亡。关于畸形手术围手术期器械并发症发生率的文献有限。我们利用SRS数据库评估2009年至2012年脊柱手术中患者的人口统计学特征、风险因素以及IRC的发生率。
查询SRS M&M数据库，获取2009年至2012年接受脊柱侧弯、椎体滑脱和后凸畸形手术患者的IRC情况。分析患者的人口统计学特征、合并症、诊断、侧弯度数以及术中特征。术中特征包括手术入路、融合或截骨操作、手术时间、失血量、使用的器械以及记录的器械并发症。
共识别出167,972例患者，其中发生311例IRC。总体IRC发生率为0.19%（每10,000例患者中有18.5例），2009年至2012年期间显著下降（从0.37%降至0.19%，P<0.001）。发生IRC的患者平均年龄为38.5±25.5岁。最常见的合并症包括高血压（23.5%）、肺部疾病（13.5%）、糖尿病（10.6%）、吸烟（8.7%）和血管疾病（7.1%）。206例（66.2%）脊柱侧弯患者、58例（18.6%）椎体滑脱患者和45例（14.5%）后凸畸形患者发生了IRC。与椎体滑脱患者相比，后凸畸形患者（0.27%对0.11%，P<0.001）和脊柱侧弯患者（0.21%对0.11%，P<0.001）发生IRC的情况显著更多。IRC包括植入物失败（23.3%）、移位（28.3%）和植入物位置不当（48.6%）。146例（46.9%）患者报告有新的围手术期神经功能缺损，其中84例（27%）的植入物被取出。
每10,000例畸形患者中约有18.5例发生IRC，后凸畸形患者的发生率显著更高。植入物位置不当这一潜在可避免的情况占这些并发症的近50%。更密切关注后方骨质解剖结构，利用导航或机器人引导改善术中成像可能会减少这些并发症。
