Department of Orthopedic Surgery, Eulji University Hospital, Daejeon, Korea.
Clin Orthop Surg. 2021 Jun;13(2):196-206. doi: 10.4055/cios20217. Epub 2021 Apr 23.
The purpose of this study was to compare clinical outcomes and complications of primary and revision surgery in patients with adult spinal deformity (ASD) accompanied by sagittal imbalance. Revision surgery has been associated with poor clinical outcomes and increased risk of complications. Previous studies comparing primary versus revision surgery included data for a wide variety of diseases and ages, but few investigated patients with ASD with sagittal imbalance undergoing anterior and posterior combined surgery.
Retrospective cohort analysis of prospectively collected data. We identified 60 consecutive patients with ASD combined with sagittal imbalance who underwent primary or revision surgery; of these, 6 patients were excluded for lack of a minimal 2-year follow-up. Patients' surgical and radiological data, clinical outcomes, and complications were reviewed.
There were 30 patients in the primary group and 24 patients in the revision group. Patient characteristics, including the prevalence of sarcopenia, were similar between the two groups. Pedicle subtraction osteotomy was performed more frequently in the revision group although there was no statistically significant difference between groups. The primary group had more proximal junctional problems, whereas the revision group had more rod breakage ( < 0.05). There were significant improvements in clinical outcomes in both groups when the preoperative and 2-year postoperative values were compared. The Oswestry disability index and visual analog scale score were similar in both groups 2 years postoperatively.
Considering the greater pain and disability at the time of the revision procedure, revision patients benefited more from surgery at the 2-year follow-up than the primary surgery patients. Complication rates were similar between the groups except for proximal junctional problems and rod breakage. Therefore, revision surgery should not be avoided in the treatment of ASD patients with sagittal imbalance.
本研究的目的是比较伴有矢状面失衡的成人脊柱畸形（ASD）患者的初次手术和翻修手术的临床结果和并发症。翻修手术与较差的临床结果和增加并发症的风险相关。以前比较初次手术与翻修手术的研究包括了各种疾病和年龄的数据，但很少有研究调查接受前路和后路联合手术的伴有矢状面失衡的 ASD 患者。
回顾性队列分析前瞻性收集的数据。我们确定了 60 例连续的伴有矢状面失衡的 ASD 患者，他们接受了初次或翻修手术；其中 6 例因缺乏至少 2 年的随访而被排除。回顾了患者的手术和影像学数据、临床结果和并发症。
初次组有 30 例患者，翻修组有 24 例患者。两组患者的特征，包括肌少症的发生率相似。虽然两组之间没有统计学上的显著差异，但翻修组更频繁地进行了经椎弓根截骨术。初次组近端交界性问题更多，而翻修组则更多地发生了棒断裂（<0.05）。两组患者的临床结果均有显著改善，与术前和 2 年术后值相比。两组患者在术后 2 年均有相似的 Oswestry 功能障碍指数和视觉模拟评分。
考虑到翻修手术时疼痛和残疾程度更大，翻修组患者在 2 年随访时比初次手术组患者从手术中获益更多。除了近端交界性问题和棒断裂外，两组的并发症发生率相似。因此，在治疗伴有矢状面失衡的 ASD 患者时，不应避免翻修手术。
