Spine Research Unit, Vall d'Hebron Research Institute, Barcelona, Spain.
Spine Surgery Unit, Vall d'Hebron University Hospital, Pg Vall Hebron 119-129, 08035, Barcelona, Spain.
Eur Spine J. 2022 Jul;31(7):1754-1764. doi: 10.1007/s00586-022-07249-0. Epub 2022 May 27.
Anterior approaches are gaining popularity for adult spinal deformity (ASD) surgeries especially with the introduction of hyperlordotic cages and improvement in MIS techniques. Combined Approaches provide powerful segmental sagittal correction potential and increase the surface area available for fusion in ASD surgery, both of which would improve overall. This is the first study directly comparing surgical outcomes between combined anterior-posterior approaches and all-posterior approach in a matched ASD population.
This is a retrospective matched control cohort analysis with substitution using a multicenter prospectively collected ASD data of patients with > 2 year FU. Matching criteria include: age, American Society of Anesthesiologists Score, Lumbar Cobb angle, sagittal deformity (Global tilt) and ODI.
In total, 1024 ASD patients were available for analysis. 29 Combined Approaches patients met inclusion criteria, and only 22 could be matched (1:2 ratio). Preoperative non-matched demographical, clinical, surgical and radiological parameters were comparable between both groups. Combined approaches had longer surgeries (548 mns vs 283) with more blood loss (2850 ml vs 1471) and needed longer ICU stays (74 h vs 27). Despite added morbidity, they had comparable complication rates but with significantly less readmissions (9.1% vs 38.1%) and reoperations (18.2% vs 43.2%) at 2 years. Combined Approaches achieved more individualised and harmonious deformity correction initially. At the 2 years control, Combined Approaches patients reported better outcomes as measured by COMI and SRS scores. This trend was maintained at 3 years.
Despite an increased initial surgical invasiveness, combined approaches seem to achieve more harmonious correction with superior sagittal deformity control; they need fewer revisions and have improved long-term functional outcomes when compared to all-posterior approaches for ASD deformity correction.
对于成人脊柱畸形（ASD）手术，前路入路越来越受欢迎，特别是随着超前凸椎间融合器的引入和微创技术的改进。联合入路提供了强大的节段矢状面矫正潜力，并增加了 ASD 手术中融合的可用表面积，这两者都将提高整体效果。这是第一项直接比较 ASD 匹配人群中联合前后入路与全后路手术的手术结果的研究。
这是一项回顾性匹配对照队列分析，使用多中心前瞻性 ASD 数据进行替代，患者随访时间超过 2 年。匹配标准包括：年龄、美国麻醉医师协会评分、腰椎 Cobb 角、矢状面畸形（整体倾斜度）和 ODI。
共有 1024 例 ASD 患者可供分析。29 例联合入路患者符合纳入标准，但只有 22 例可匹配（1:2 比例）。两组间术前非匹配的人口统计学、临床、手术和影像学参数具有可比性。联合入路手术时间较长（548 分钟比 283 分钟），出血量较大（2850ml 比 1471ml），ICU 停留时间较长（74 小时比 27 小时）。尽管增加了发病率，但联合入路组的并发症发生率相似，但在 2 年时，再入院率（9.1%比 38.1%）和再次手术率（18.2%比 43.2%）明显较低。联合入路最初实现了更个体化和更和谐的畸形矫正。在 2 年的随访时，联合入路组患者报告的 COMI 和 SRS 评分结果更好。这一趋势在 3 年时仍保持不变。
尽管初始手术侵袭性增加，但与全后路入路相比，联合入路似乎能更和谐地矫正畸形，更好地控制矢状面畸形；对于 ASD 畸形矫正，联合入路需要更少的翻修，并且具有更好的长期功能结果。
