Bari Tanvir Johanning, Hansen Lars Valentin, Gehrchen Martin
Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark.
Spine Deform. 2020 Oct;8(5):1027-1037. doi: 10.1007/s43390-020-00112-6. Epub 2020 Apr 11.
Single-center, retrospective.
To assess the restoration of ideal sagittal spine shape in accordance to the Roussouly classification and the effect on postoperative mechanical complications. Surgical correction of Adult Spinal Deformity is both challenging and complex. The risk of postoperative complications is considerable, especially mechanical complications requiring revision surgery. Attention has been directed toward defining alignment targets in attempts to minimize these risks, and the Roussouly classification has been proposed as a potential surgical aim.
All patients undergoing ASD surgery from 2013-2016 were included at a single, quaternary institute. Successful restoration of Roussouly spine shape was retrospectively assessed, and patients were classified as either "restored" or "non-restored". Cumulative incidence of revision surgery due to mechanical failure was estimated using the Aalen-Johansen estimator, with death as the competing risk. A multivariable proportional odds model was used to estimate the effect of the Roussouly algorithm on revision surgery due to mechanical failure.
We identified a complete and consecutive cohort of 233 patients who were followed for a mean period of 36 (± 14) months. The 2-year cumulative incidence of revision surgery was 28%. Comparing the "restored" to the "non-restored" group, the overall revision rates were high in both groups. However, when adjusting for known cofounders in a multivariable proportional odds analysis, there was an almost fivefold increased odds of revision due to mechanical failure in the "non-restored" group (p = 0.036).
Surgical correction of ASD in accordance to the ideal Roussouly spine shape was correlated to a marked and significant decrease in risk of revision surgery due to mechanical failure. Nonetheless, the overall revision risk was elevated in both groups.
Therapeutic III.
单中心回顾性研究。
根据鲁苏利分类法评估理想矢状面脊柱形态的恢复情况以及对术后机械性并发症的影响。成人脊柱畸形的手术矫正既具有挑战性又很复杂。术后并发症的风险相当高，尤其是需要翻修手术的机械性并发症。人们已将注意力转向确定对线目标以尽量降低这些风险，并且鲁苏利分类法已被提议作为一个潜在的手术目标。
纳入2013年至2016年在一家单一的四级医疗机构接受成人脊柱畸形手术的所有患者。对鲁苏利脊柱形态的成功恢复进行回顾性评估，患者被分为“恢复”或“未恢复”两类。使用阿伦 - 约翰森估计量估计因机械故障导致的翻修手术的累积发生率，将死亡作为竞争风险。采用多变量比例优势模型估计鲁苏利算法对因机械故障导致的翻修手术的影响。
我们确定了一个完整且连续的队列，共233例患者，平均随访时间为36（±14）个月。翻修手术的2年累积发生率为28%。将“恢复”组与“未恢复”组进行比较，两组的总体翻修率都很高。然而，在多变量比例优势分析中对已知混杂因素进行调整后，“未恢复”组因机械故障导致翻修的几率几乎增加了五倍（p = 0.036）。
按照理想的鲁苏利脊柱形态进行成人脊柱畸形的手术矫正与因机械故障导致的翻修手术风险显著降低相关。尽管如此，两组的总体翻修风险均有所升高。
治疗性III级。
