Turku University Hospital, Division of Clinical Neurosciences, Department of Neurosurgery, Turku, Finland.
University of Turku, Faculty of Medicine, Department of Clinical Medicine, Turku, Finland.
Neurosurgery. 2021 Feb 16;88(3):558-573. doi: 10.1093/neuros/nyaa464.
Surgery for degenerative cervical spine disease has escalated since the 1990s. Fusion has become the mainstay of surgery despite concerns regarding adjacent segment degeneration. The patient-specific trends in reoperations have not been studied previously.
To analyze the occurrence, risk factors, and trends in reoperations in a long-term follow-up of all the patients operated for degenerative cervical spine disease in Finland between 1999 and 2015.
The patients were retrospectively identified from the Hospital Discharge Registry. Reoperations were traced individually; only reoperations occurring >365 d after the primary operation were included. Time trends in reoperations and the risk factors were analyzed by regression analysis.
Of the 19 377 identified patients, 9.2% underwent a late reoperation at a median of 3.6 yr after the primary operation. The annual risk of reoperation was 2.4% at 2 yr, 6.6% at 5 yr, 11.1% at 10 yr, and 14.2% at 15 yr. Seventy-five percent of the late reoperations occurred within 6.5 yr of the primary operation. Foraminal stenosis, the anterior cervical decompression and fusion (ACDF) technique, male gender, weak opiate use, and young age were the most important risk factors for reoperation. There was no increase in the risk of reoperations over the follow-up period.
The risk of reoperation was stable between 1999 and 2015. The reoperation risk was highest during the first 6 postoperative years and then declined. Patients with foraminal stenosis had the highest risk of reoperation, especially when ACDF was performed.
自 20 世纪 90 年代以来，退行性颈椎疾病的手术治疗不断增加。尽管存在对相邻节段退变的担忧，但融合仍然是手术的主要方法。之前尚未研究过特定患者再次手术的趋势。
分析 1999 年至 2015 年期间在芬兰接受退行性颈椎疾病手术的所有患者的长期随访中再次手术的发生、风险因素和趋势。
通过住院患者记录数据库回顾性识别患者。单独追踪再次手术；仅纳入距初次手术>365 d 后的再次手术。通过回归分析评估再次手术的时间趋势和风险因素。
在 19377 例患者中，9.2%在初次手术后中位数为 3.6 年时进行了晚期再次手术。初次手术后 2 年、5 年、10 年和 15 年的再次手术年度风险分别为 2.4%、6.6%、11.1%和 14.2%。75%的晚期再次手术发生在初次手术 6.5 年内。椎间孔狭窄、前路颈椎减压融合术（ACDF）技术、男性、弱阿片类药物使用和年轻是再次手术的最重要风险因素。随访期间再次手术的风险没有增加。
1999 年至 2015 年期间，再次手术的风险保持稳定。术后 6 年内再次手术风险最高，然后逐渐下降。存在椎间孔狭窄的患者再次手术风险最高，尤其是当施行 ACDF 时。
