Godolias Periklis, Frieler Sven, Tataryn Zachary L, McBride Paul, Nunna Ravi, Ghayoumi Pouriya, Charlot Kaarina, Tran Angela, Al-Awadi Hamzah, Gerstmeyer Julius R, Ruetten Sebastian, Chapman Jens R, Oskouian Rod J
Seattle Science Foundation, Seattle, WA, USA.
Department of Orthopedics and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany.
Global Spine J. 2024 Jan;14(1):130-137. doi: 10.1177/21925682221096621. Epub 2022 Apr 21.
Retrospective cohort study.
With steadily increasing implementation of far lateral approaches in spine surgery, surgeons can utilize the advantages of different approaches synergistically to ensure an optimal patient outcome. Our single institution study aimed to assess the complication rates of patients who underwent a lateral interbody fusion as the index procedure and additional anterior or posterior instrumentation as part of a planned staged surgical reconstruction effort.
This study was approved by our institutional review board (STUDY2021000113). We included 576 patients who received a lateral lumbar interbody fusion (LLIF) as the index procedure followed by transforaminal lumbar interbody fusion (TLIF), posterior lumbar interbody fusion (PLIF) or anterior lumbar interbody fusion (ALIF) between 2016 and 2020. Primary outcomes were complications identified during the initial inpatient stay, which were categorized into approach-related and secondary complications. Secondary outcomes tracked up to 6 years post-surgery.
The overall complication rate was 19.2% (10.5% approach related, 8.7% secondary complications). Significant intraoperative hemorrhage (mean 659.3 mL vs 131.4 mL, < .01) was the most common approach related complication with an incidence of 4%, followed by temporary hip flexor weakness in 2.6%. A permanent (femoral) nerve damage was verified in 1 patient. The most common secondary complication was impaired wound healing in 12 patients (2.1%). We identified a 7.1% (41 of 576 patients) rate of revision surgery, on average after 372 days (±34 days).
We recorded an overall complication rate of 19.2% for staged adult deformity corrective surgeries utilizing far lateral interbody fusions at several lumbar levels followed by a more comprehensive posterior surgical reconstruction.
回顾性队列研究。
随着脊柱手术中极外侧入路的应用不断增加，外科医生可以协同利用不同入路的优势，以确保患者获得最佳治疗效果。我们的单机构研究旨在评估接受外侧椎间融合作为索引手术，并作为计划分期手术重建一部分进行额外前路或后路内固定的患者的并发症发生率。
本研究经我们的机构审查委员会批准（研究编号：STUDY2021000113）。我们纳入了576例患者，这些患者在2016年至2020年间接受了腰椎外侧椎间融合（LLIF）作为索引手术，随后接受了经椎间孔腰椎椎间融合（TLIF）、后路腰椎椎间融合（PLIF）或前路腰椎椎间融合（ALIF）。主要结局是在初次住院期间发现的并发症，分为与入路相关的并发症和继发性并发症。次要结局追踪至术后6年。
总体并发症发生率为19.2%（与入路相关的为10.5%，继发性并发症为8.7%）。术中大出血（平均659.3毫升对131.4毫升，P<0.01）是最常见的与入路相关的并发症，发生率为4%，其次是临时髋屈肌无力，发生率为2.6%。1例患者被证实存在永久性（股）神经损伤。最常见的继发性并发症是12例患者（2.1%）伤口愈合受损。我们发现翻修手术率为7.1%（576例患者中的41例），平均在372天（±34天）后进行。
我们记录了在多个腰椎节段采用极外侧椎间融合并随后进行更全面的后路手术重建的分期成人畸形矫正手术的总体并发症发生率为19.2%。
