Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark.
Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark.
Spine J. 2021 Apr;21(4):642-652. doi: 10.1016/j.spinee.2020.12.002. Epub 2020 Dec 17.
Revision risk after pediatric spine surgery is not well established and varies between deformity etiologies.
To report the 2-year revision risk following surgery for primary pediatric spinal deformity in a nationwide cohort and to evaluate potential risk factors and reasons for revision surgery.
Retrospective nationwide cohort study.
A national registry study of all pediatric spinal deformity patients undergoing surgery during 2006-2015 (n=1310).
Two-year revision risk.
All patients ≤21 years of age undergoing spinal deformity surgery in Denmark during 2006-2015 were identified by procedure and diagnosis codes in the Danish National Patient Registry (DNPR). Data on revision surgery were retrieved from the DNPR. Patients were categorized in six groups according to etiology. Medical records were reviewed for reason for revision in all patients. Potential risk factors for revision were assessed with multiple logistic regression analyses and included age, etiology, sex, Charlson comorbidity index (CCI), and growth-preserving treatment.
Patients were categorized according to etiology: idiopathic deformity (53%), neuromuscular deformity (23%), congenital/structural deformity (9%), spondylolisthesis (7%), Scheuermann's kyphosis (5%), and syndromic deformity (3%). Of 1,310 included patients, 9.2% underwent revision surgery within 2 years and 1.5% was revised more than once. Median time to revision was 203 (interquartile range 35-485) days. The multivariable logistic regression found significantly higher odds ratio (OR) for revision in patients with growth-preserving treatment (OR=5.1, 95% confidence interval [CI] 2.6-10.1), congenital deformity (OR=2.7, 95% CI 1.3-5.3), spondylolisthesis (OR=3.5, 95% CI 1.9-6.7), Scheuermann kyphosis (OR=3.9, 95% CI 1.9-8.3), and CCI score ≥3 (OR=2.5 95% CI 1.1-5.6). The most common reason for revision was implant failure (32.5%) followed by residual deformity and/or curve progression (15.8%).
In this nationwide study, the 2-year revision risk after primary pediatric spinal deformity surgery is 9.2%. Risk factors for revision are etiology of congenital deformity, spondylolisthesis, Scheuermann kyphosis as well as patients with growth-preserving treatment and higher CCI. The most common reason for revision is implant failure.
儿童脊柱手术后的翻修风险尚不清楚，且因畸形病因不同而有所差异。
报告全国范围内儿童脊柱畸形初次手术 2 年后的翻修风险，并评估潜在的风险因素和翻修手术的原因。
回顾性全国队列研究。
丹麦全国脊柱畸形患者数据库（DNPR）中 2006 年至 2015 年间接受脊柱畸形手术的所有儿童患者（n=1310）。
2 年翻修风险。
通过手术和诊断代码，在丹麦全国患者登记处（DNPR）中确定所有 21 岁以下接受脊柱畸形手术的患者。从 DNPR 中检索到翻修手术的数据。根据病因将患者分为 6 组。对所有患者的翻修原因进行了病历回顾。采用多因素逻辑回归分析评估了翻修的潜在风险因素，包括年龄、病因、性别、Charlson 合并症指数（CCI）和生长保留治疗。
患者根据病因分类：特发性畸形（53%）、神经肌肉性畸形（23%）、先天性/结构性畸形（9%）、脊椎滑脱（7%）、Scheuermann 后凸（5%）和综合征性畸形（3%）。在纳入的 1310 名患者中，9.2%的患者在 2 年内接受了翻修手术，1.5%的患者接受了多次翻修。中位翻修时间为 203（四分位间距 35-485）天。多变量逻辑回归发现，生长保留治疗（比值比[OR] 5.1，95%置信区间[CI] 2.6-10.1）、先天性畸形（OR 2.7，95%CI 1.3-5.3）、脊椎滑脱（OR 3.5，95%CI 1.9-6.7）、Scheuermann 后凸（OR 3.9，95%CI 1.9-8.3）和 CCI 评分≥3（OR 2.5，95%CI 1.1-5.6）的患者翻修风险显著更高。翻修的最常见原因是植入物失败（32.5%），其次是残留畸形和/或曲线进展（15.8%）。
在这项全国性研究中，儿童脊柱畸形初次手术后 2 年的翻修风险为 9.2%。翻修的风险因素是先天性畸形、脊椎滑脱、Scheuermann 后凸以及接受生长保留治疗和更高 CCI 的患者。翻修的最常见原因是植入物失败。
