Nielsen Ena, Andras Lindsay M, Siddiqui Ali A, Michael Nicole, Garg Sumeet, Paloski Michael, Brighton Brian K, Ferrero Emmanuelle, Mazda Keyvan, Ilharreborde Brice, Skaggs David L
Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd, Mailstop #69, Los Angeles, CA, 90027, USA.
Orthopedics Institute, Children's Hospital Colorado, Aurora, USA.
Spine Deform. 2020 Oct;8(5):1059-1067. doi: 10.1007/s43390-020-00121-5. Epub 2020 May 6.
Multicenter retrospective.
To determine the long-term complication rate associated with surgical treatment of spondylolisthesis in adolescents. There is limited information on the complication rate associated with posterior spinal fusion (PSF) of spondylolisthesis in the pediatric and adolescent population.
Patients who underwent PSF for spondylolisthesis between 2004 and 2015 at four spine centers, < 21 years of age, were included. Exclusion criteria were < 2 years of follow-up or anterior approach. Charts and radiographs were reviewed.
50 patients had PSF for spondylolisthesis, 26 had PSF alone, while 24 had PSF with trans-foraminal lumbar interbody fusion (TLIF). Mean age was 13.9 years (range 9.6-18.4). Mean follow-up was 5.5 years (range 2-15). Mean preoperative slip was 61.2%. 20/50 patients (40%) experienced 23 complications requiring reoperation at a mean of 2.1 years (range 0-9.3) for the following: implant failure (12), persistent radiculopathy (3), infection (3), persistent back pain (2), extension of fusion (2), and hematoma (1). In addition, there were 22 cases of radiculopathy (44%) that were transient. Rate of implant failure was related to preoperative slip angle (p = 0.02). Reoperation rate and rates of implant failure were not associated with preoperative % slip (reoperation: p = 0.42, implant failure: p = 0.15), postoperative % slip (reoperation: p = 0.42, implant failure: p = 0.99), postoperative kyphosis of the lumbosacral angle (reoperation: p = 0.81, implant failure: p = 0.48), change in % slip (reoperation: p = 0.30, implant failure: p = 0.12), change in slip angle (reoperation: p = 0.42, implant failure: p = 0.40), graft used (reoperation: p = 0.22, implant failure: p = 0.81), or addition of a TLIF (reoperation: p = 0.55, implant failure: p = 0.76).
PSF of spondylolisthesis in the adolescent population was associated with a 40% reoperation rate and high rate of post-operative radiculopathy. Addition of a TLIF did not impact reoperation rate or rate of radiculopathy.
多中心回顾性研究。
确定青少年腰椎滑脱症手术治疗的长期并发症发生率。关于小儿及青少年人群腰椎滑脱症后路脊柱融合术（PSF）相关并发症发生率的信息有限。
纳入2004年至2015年间在四个脊柱中心接受PSF治疗腰椎滑脱症、年龄小于21岁的患者。排除标准为随访时间小于2年或采用前路手术。查阅病历和X光片。
50例患者因腰椎滑脱症接受了PSF，其中26例仅接受了PSF，24例接受了PSF联合经椎间孔腰椎椎间融合术（TLIF）。平均年龄为13.9岁（范围9.6 - 18.4岁）。平均随访时间为5.5年（范围2 - 15年）。术前平均滑脱率为61.2%。20/50例患者（40%）出现23种并发症，平均在2.1年（范围0 - 9.3年）后需要再次手术，原因如下：内植物失败（12例）、持续性神经根病（3例）、感染（3例）、持续性背痛（2例）、融合节段延长（2例）和血肿（1例）。此外，有22例神经根病（44%）为短暂性。内植物失败率与术前滑脱角相关（p = 0.02）。再次手术率和内植物失败率与术前滑脱百分比（再次手术：p = 0.42，内植物失败：p = 0.15）、术后滑脱百分比（再次手术：p = 0.42，内植物失败：p = 0.99）、腰骶角术后后凸（再次手术：p = 0.81，内植物失败：p = 0.48）、滑脱百分比变化（再次手术：p = 0.30，内植物失败：p = 0.12）、滑脱角变化（再次手术：p = 0.42，内植物失败：p = 0.40）、使用的植骨材料（再次手术：p = 0.22，内植物失败：p = 0.81）或是否加做TLIF（再次手术：p = 0.55，内植物失败：p = 0.76）无关。
青少年腰椎滑脱症的PSF与40%的再次手术率和较高的术后神经根病发生率相关。加做TLIF对再次手术率或神经根病发生率无影响。
