Ishak Basem, Abdul-Jabbar Amir, Glinski Alexander von, Yilmaz Emre, Unterberg Andreas W, Hopkins Sarah, Roh Jeffrey, Oskouian Rod, Hart Robert, Chapman Jens R
Swedish Neuroscience Institute, Seattle, WA, USA.
Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany.
Global Spine J. 2023 Jan;13(1):164-171. doi: 10.1177/2192568221994793. Epub 2021 Mar 10.
Retrospective cohort study.
The purpose of the study was to compare early complication, morbidity and mortality risks associated with fusion surgery crossing the cervico-thoracic junction in patients aged over 80 years undergoing combined anterior and posterior approach versus a posterior-only approach.
We retrospectively identified octogenarian patients with myelopathy who underwent fusion crossing the cervico-thoracic junction. Patient demographics, Nurick score, surgical characteristics, complications, hospital course, early outcome and 90-day mortality were collected. Comorbidities were classified using the age-adjusted Charlson Comorbidity Index (AACCI). Radiographic measurements for deformity correction included the C2-C7 sagittal Cobb angle, C2-7 sagittal vertical axis and T1 slope pre- and postoperatively.
Out of 8,521 surgically treated patients, 12 octogenarian patients had a combined anterior and posterior approach (AP group) and 14 were treated from posterior-only (P group). Mean age was 81.4 ± 1.2 and 82.5 ± 2.7 years, respectively. There was no significant difference in Nurick scores between the groups ( > 0.05). The major complication risk in the AP group was significantly higher, requiring PEG tube placement due to severe dysphagia in 4 patients (33%) compared to none in the P group. A greater improvement in cervical lordosis could be achieved through a combined approach. The 90-day mortality risk was 8% for the AP group and 0% for the P group.
A combined anterior and posterior approach is associated with a significantly higher major complication rate and can result in severe dysphagia requiring PEG tube placement in one-third of patients over 80 years of age.
回顾性队列研究。
本研究旨在比较80岁以上患者采用前后联合入路与单纯后入路进行跨越颈胸交界区融合手术的早期并发症、发病率和死亡率风险。
我们回顾性确定了接受跨越颈胸交界区融合手术的老年脊髓病患者。收集患者的人口统计学资料、Nurick评分、手术特征、并发症、住院过程、早期结局和90天死亡率。使用年龄调整的Charlson合并症指数（AACCI）对合并症进行分类。畸形矫正的影像学测量包括术前和术后的C2-C7矢状面Cobb角、C2-7矢状垂直轴和T1斜率。
在8521例接受手术治疗的患者中，12例老年患者采用前后联合入路（AP组），14例采用单纯后入路（P组）。平均年龄分别为81.4±1.2岁和82.5±2.7岁。两组之间的Nurick评分无显著差异（>0.05）。AP组的主要并发症风险显著更高，4例患者（33%）因严重吞咽困难需要放置PEG管，而P组无此情况。通过联合入路可以实现颈椎前凸的更大改善。AP组的90天死亡率风险为8%，P组为0%。
前后联合入路与显著更高的主要并发症发生率相关，并且可能导致三分之一的80岁以上患者出现严重吞咽困难，需要放置PEG管。
