Nwachuku Enyinna L, Mehta Amol, Alan Nima, Agarwal Nitin, Okonkwo David O, Hamilton David K, Kanter Adam S, Thirumala Parthasarathy D
Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Interdiscip Neurosurg. 2018 Dec;14:18-23. doi: 10.1016/j.inat.2018.04.006. Epub 2018 Apr 13.
The rates of arthrodesis performed in the United States and globally have increased tremendously in the last 10-15 years. Amongst the most devastating complications are neurological deficits including spinal cord injury, nerve root irritation, and cauda equine syndrome. The primary purpose of this study is to understand the risk factors for perioperative neurological deficits in patients undergoing thoracolumbar fusion.
Data from the Nationwide Inpatient Sample between the years of 1999-2011 was analyzed. Patients were between the ages of 18 and 80 who had thoracolumbar fusion. Excluded were patients who underwent the procedure as a result of trauma or a malignancy. A list of covariates, including demographic variables, preoperative and postoperative variables that are known to increase the risk of perioperative neurological deficits were compiled. Statistical analysis utilized univariate and multivariate logistic regression for comparisons between these covariates and the proposed outcomes.
The analysis of 37,899 patients yielded an overall rate of perioperative neurological deficits and mortality of 1.20% and 0.27%, respectively. Risk factors for perioperative neurological deficits included increasing age (OR 1.023 95% CI 1.018-1.029), Van Walraven 5-14 (OR 1.535 95% CI 1.054-2.235), and preoperative paralysis (OR 2.551 95% CI 1.674-3.886). Furthermore, the data showed that being 65 years old or older doubled the risk for perioperative deficit (OR 1.655, CI 1.248-2.194, p < 0.001).
This population based study found that increasing age, higher comorbid burden, and preoperative paralysis increased the risk of perioperative neurological deficits while female gender and hypertension were found to be protective.
在过去10至15年中，美国和全球范围内进行关节融合术的比率大幅上升。其中最具毁灭性的并发症是神经功能缺损，包括脊髓损伤、神经根刺激和马尾综合征。本研究的主要目的是了解接受胸腰椎融合术患者围手术期神经功能缺损的危险因素。
分析了1999年至2011年全国住院患者样本中的数据。患者年龄在18至80岁之间，接受了胸腰椎融合术。因创伤或恶性肿瘤接受该手术的患者被排除在外。编制了一份协变量清单，包括人口统计学变量、已知会增加围手术期神经功能缺损风险的术前和术后变量。统计分析采用单变量和多变量逻辑回归，以比较这些协变量与预期结果。
对37899名患者的分析显示，围手术期神经功能缺损和死亡率分别为1.20%和0.27%。围手术期神经功能缺损的危险因素包括年龄增长（比值比1.023，95%置信区间1.018 - 1.029）、Van Walraven 5 - 14（比值比1.535，95%置信区间1.054 - 2.235）和术前瘫痪（比值比2.551，95%置信区间1.674 - 3.886）。此外，数据显示65岁及以上患者围手术期神经功能缺损风险增加一倍（比值比1.655，置信区间1.248 - 2.194，p < 0.001）。
这项基于人群的研究发现，年龄增长、更高的合并症负担和术前瘫痪会增加围手术期神经功能缺损风险，而女性和高血压具有保护作用。
