Lafage Renaud, Fong Alex M, Klineberg Eric, Smith Justin S, Bess Shay, Shaffrey Christopher I, Burton Douglas, Kim Han Jo, Elysee Jonathan, Mundis Gregory M, Passias Peter, Gupta Munish, Hostin Richard, Schwab Frank, Lafage Virginie
1Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York.
2Department of Orthopedic Surgery, School of Medicine, University of California, Davis, California.
J Neurosurg Spine. 2021 Dec 24;36(6):1012. doi: 10.3171/2021.10.SPINE21795. Print 2022 Jun 1.
Adult spinal deformity is a complex pathology that benefits greatly from surgical treatment. Despite continuous innovation, little is known regarding continuous changes in surgical techniques and the complications rate. The objective of the current study was to investigate the evolution of the patient profiles and surgical complications across a single prospective multicenter database.
This study is a retrospective review of a prospective, multicenter database of surgically treated patients with adult spinal deformity (thoracic kyphosis > 60°, sagittal vertical axis > 5 cm, pelvic tilt > 25°, or Cobb angle > 20°) with a minimum 2-year follow-up. Patients were stratified into 3 equal groups by date of surgery. The three groups' demographic data, preoperative data, surgical information, and complications were then compared. A moving average of 320 patients was used to visualize and investigate the evolution of the complication across the enrollment period.
A total of 928/1260 (73.7%) patients completed their 2-year follow-up, with an enrollment rate of 7.7 ± 4.1 patients per month. Across the enrollment period (2008-2018) patients became older (mean age increased from 56.7 to 64.3 years) and sicker (median Charlson Comorbidity Index rose from 1.46 to 2.08), with more pure sagittal deformity (type N). Changes in surgical treatment included an increased use of interbody fusion, more anterior column release, and a decrease in the 3-column osteotomy rate, shorter fusion, and more supplemental rods and bone morphogenetic protein use. There was a significant decrease in major complications associated with a reoperation (from 27.4% to 17.1%) driven by a decrease in radiographic failures (from 12.3% to 5.2%), despite a small increase in neurological complications. The overall complication rate has decreased over time, with the lowest rate of any complication (51.8%) during the period from August 2014 to March 2017. Major complications associated with reoperation decreased rapidly in the 2014-2015. Major complications not associated with reoperation had the lowest level (21.0%) between February 2014 and October 2016.
Despite an increase in complexity of cases, complication rates did not increase and the rate of complications leading to reoperation decreased. These improvements reflect the changes in practice (supplemental rod, proximal junctional kyphosis prophylaxis, bone morphogenetic protein use, anterior correction) to ensure maintenance of status or improved outcomes.
成人脊柱畸形是一种复杂的病症，手术治疗能带来显著益处。尽管不断有创新，但对于手术技术的持续变化和并发症发生率却知之甚少。本研究的目的是通过一个前瞻性多中心数据库来调查患者特征和手术并发症的演变情况。
本研究是对一个前瞻性多中心数据库的回顾性分析，该数据库收录了接受手术治疗的成人脊柱畸形患者（胸椎后凸>60°、矢状垂直轴>5 cm、骨盆倾斜>25°或Cobb角>20°），且患者至少有2年的随访数据。根据手术日期将患者分为3组，每组人数相等。然后比较三组的人口统计学数据、术前数据、手术信息和并发症情况。采用320例患者的移动平均值来直观呈现整个入组期间并发症的演变情况并进行调查。
共有928/1260例（73.7%）患者完成了2年随访，每月入组率为7.7±4.1例。在整个入组期间（2008 - 2018年），患者年龄增大（平均年龄从56.7岁增至64.3岁）且病情加重（Charlson合并症指数中位数从1.46升至2.08），矢状面单纯畸形（N型）增多。手术治疗的变化包括椎间融合术使用增加、前柱松解增多、三联截骨率降低、融合节段缩短以及补充棒和骨形态发生蛋白的使用增多。与再次手术相关联的严重并发症显著减少（从27.4%降至17.1%），这是由影像学失败率降低（从12.3%降至5.2%）所致尽管神经并发症略有增加。整体并发症发生率随时间下降，在2014年8月至2017年3月间任何并发症的发生率最低（51.8%）再次手术相关联严重并发症在2014 - 2015年迅速下降。非再次手术相关联的严重并发症在2014年2月至2016年10月间降至最低水平（21.0%）
尽管病例复杂性增加，但并发症发生率并未升高而且导致再次手术的并发症发生率下降。这些改进反应了实际操作中的变化（补充棒、近端交界性后凸预防、骨形态发生蛋白使用前侧矫正）以确保持续状态或改善预后。
