Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
World Neurosurg. 2022 Feb;158:e865-e879. doi: 10.1016/j.wneu.2021.11.086. Epub 2021 Nov 24.
One potentially fatal complication of spine surgery is myocardial infarction (MI). There is still uncertainty of the true incidence of MI within subsets of spine surgeries. The aim of this study was to survey the contemporary spine literature and ascertain the true incidence of MI after lumbar spine surgery, as well as to provide commentary on the inherent assumptions made when interpreting cohort versus database studies on this topic.
A systematic search of 4 electronic databases from inception to November 2020 was conducted following PRISMA guidelines. Articles were screened against prespecified criteria. MI incidence was then estimated by random-effects meta-analyses of proportions based on cohort versus database studies.
A total of 34 cohort studies and 32 database studies describing 767,326 lumbar procedures satisfied all criteria for selection. There were 12,170 (2%) cases from cohort studies and 755,156 (98%) cases from database studies. Cohort studies reported a significantly older patient cohort (P < 0.01) and longer follow-up period than did database studies (P < 0.03). Using cohort studies only, the incidence of MI was 0.44% (P heterogeneity < 0.01), whereas using database studies only, the incidence of MI was 0.41% (P heterogeneity < 0.01). These 2 incidences were statistically different (P interaction = 0.01). Bias analysis indicated that cohort studies were more vulnerable to small-study biases than were database studies.
Although infrequent, the incidence of MI after lumbar spine surgery is unequivocally nonzero. Furthermore, the literature on this topic remains skewed based on study type, and translation of academic findings into practice should be wary of this.
脊柱手术的一个潜在致命并发症是心肌梗死（MI）。在脊柱手术的亚组中，MI 的真实发生率仍不确定。本研究的目的是调查当代脊柱文献，确定腰椎手术后 MI 的真实发生率，并就解释关于该主题的队列研究和数据库研究时所做的内在假设提供评论。
根据 PRISMA 指南，从成立到 2020 年 11 月，对 4 个电子数据库进行了系统搜索。根据预先确定的标准对文章进行筛选。然后，根据队列研究和数据库研究，通过随机效应荟萃分析比例来估计 MI 的发生率。
共有 34 项队列研究和 32 项数据库研究描述了 767326 例腰椎手术，符合所有入选标准。队列研究中有 12170 例（2%），数据库研究中有 755156 例（98%）。队列研究报告的患者年龄较大（P < 0.01）且随访时间较长（P < 0.03）。仅使用队列研究，MI 的发生率为 0.44%（P 异质性 < 0.01），而仅使用数据库研究，MI 的发生率为 0.41%（P 异质性 < 0.01）。这两个发生率有统计学差异（P 交互 = 0.01）。偏倚分析表明，队列研究比数据库研究更容易受到小样本研究的偏倚影响。
尽管罕见，但腰椎手术后 MI 的发生率确实为非零。此外，该主题的文献仍然存在研究类型的偏差，在将学术发现转化为实践时应该对此保持警惕。
