Martini Michael L, Nistal Dominic A, Gal Jonathan, Neifert Sean N, Rothrock Robert J, Kim Jinseong D, Deutsch Brian C, Genadry Lisa, Lamb Colin D, Caridi John M
Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
World Neurosurg. 2020 Jul;139:e480-e488. doi: 10.1016/j.wneu.2020.04.053. Epub 2020 Apr 18.
This is the first large retrospective analysis of patients undergoing anterior lumbar interbody fusion (ALIF) with concern for clinical determinants leading to reoperation for adjacent segment disease (ASD). The objective of this study is to examine the specific perioperative and clinical determinants that affect need for adjacent segment reoperation in patients who underwent 1-level and 2-level ALIF procedures for degenerative disc disorders.
All cases at our institution between 2008 and 2016 involving an ALIF performed for degenerative disc disorders at 1 or 2 levels were examined. A total of 404 ALIF cases, of which 268 were single-level (66.33%) and 136 were 2-level procedures (33.67%), were included. Adjacent segment reoperation was the primary outcome. Secondary outcomes included increased blood loss, extended surgery duration, greater nonhome discharge, extended hospitalization, and higher total direct costs. Univariate and multivariate logistic regression assessed how number of levels fused related to perioperative outcomes.
The patient cohorts shared similar demographic characteristics and showed expected differences in certain intraoperative outcomes. After controlling for preoperative and intraoperative variables, multivariate regression showed that patients who underwent 2-level ALIFs experienced increased odds of adjacent segment reoperation (P = 0.0424) but no other adverse clinical outcomes.
Our findings support a biomechanical hypothesis of ASD onset after fusion, suggesting that the risk of ASD after ALIF lies primarily in the number of levels fused rather than any demographic or intraoperative variables.
这是首次对接受前路腰椎椎间融合术（ALIF）的患者进行的大型回顾性分析，关注导致相邻节段疾病（ASD）再次手术的临床决定因素。本研究的目的是检查在因退行性椎间盘疾病接受单节段和双节段ALIF手术的患者中，影响相邻节段再次手术需求的特定围手术期和临床决定因素。
对2008年至2016年期间在本机构进行的所有1或2节段退行性椎间盘疾病ALIF手术病例进行检查。共纳入404例ALIF病例，其中268例为单节段手术（66.33%），136例为双节段手术（33.67%）。相邻节段再次手术是主要结局。次要结局包括失血增加、手术时间延长、非家庭出院增多、住院时间延长和总直接费用增加。单因素和多因素逻辑回归评估融合节段数与围手术期结局的关系。
患者队列具有相似的人口统计学特征，在某些术中结局方面存在预期差异。在控制术前和术中变量后，多因素回归显示接受双节段ALIF手术的患者相邻节段再次手术的几率增加（P = 0.0424），但无其他不良临床结局。
我们的研究结果支持融合后ASD发病的生物力学假说，表明ALIF术后ASD的风险主要在于融合节段数，而非任何人口统计学或术中变量。
