Department of Neurological Surgery, Vanderbilt University Medical Center, Medical Center North T-4224, Nashville, TN, 37212, USA.
Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
Spine Deform. 2023 Jan;11(1):175-185. doi: 10.1007/s43390-022-00576-8. Epub 2022 Sep 5.
(a) Describe the time course of each mechanical complication, and (b) compare radiographic measurements and preoperative patient-reported outcome measures (PROMs) among each mechanical complication type.
A single-institution case-control study was undertaken of patients undergoing adult spinal deformity (ASD) surgery from 2009-2017. Exposure variables included patient demographics, operative variables, radiographic measurements, and preoperative PROMs, including Oswestry Disability Index (ODI), Numeric Rating Scale Back/Leg-pain scores (NRS-Back/Leg), and EuroQol-5D (EQ-5D). The primary outcomes were occurrence of a mechanical complication and time to complication. Due to overlapping occurrence, rod fracture and pseudarthrosis were grouped into one composite category.
145 patients underwent ASD surgery and were followed for at least 2 years. 30/47 (63.8%) patients with proximal junctional kyphosis (PJK) required reoperation, whereas 27/31 (87.1%) patients with pseudarthrosis/rod fracture required reoperation (63.8% vs. 87.1%, Χ = -0.23, 95% CI -0.41, -0.05, p = 0.023). Cox regression showed no significant difference in time to reoperation between PJK and rod fracture/pseudarthrosis (HR = 0.97, 95% CI 0.85-1.11, p = 0.686). Distal junctional kyphosis (DJK) (N = 3; 2 reoperation) and implant failures (N = 4; 0 reoperations) were rare. Patients with PJK had significantly lower Hounsfield Units preoperatively compared to those with pseudarthrosis/rod fracture (138.2 ± 43.8 vs. 160.3 ± 41.0, mean difference (MD) = -22.1, 95% CI -41.8, -2.4, p = 0.028), more prior fusions (51.1% vs. 25.8%, Χ = 0.253, 95% CI 0.41, 0.46, p = 0.026), fewer instrumented vertebrae (9.2 ± 2.6 vs. 10.7 ± 2.5, MD = -1.5, 95% CI -2.7, -0.31, p = 0.013), and higher postoperative thoracic kyphosis (TK) (46.3 ± 12.7 vs. 34.9 ± 10.6, MD = 11.4, 95% CI 5.9, 16.9, p < 0.001). Higher postoperative C7 sagittal vertical axis (SVA) did not achieve a significant difference (80.7 ± 72.1 vs. 51.9 ± 57.3, MD = 28.8, 95% CI -1.9, 59.5, p = 0.066). No differences were seen in preoperative PROMs.
Patients with pseudarthrosis/rod fracture had a higher reoperation rate compared to those with PJK with similar time to reoperation. Moreover, patients with PJK had higher postoperative TK, lower Hounsfield Units, more prior fusions, and fewer instrumented levels compared to those with pseudarthrosis/rod fracture. The results of this single-institution study suggest that even though mechanical complications are often analyzed as a single group, important differences may exist between them.
III.
(a) 描述每种机械并发症的时间过程，以及 (b) 比较每种机械并发症类型的影像学测量值和术前患者报告的结果测量指标 (PROMs)。
对 2009-2017 年接受成人脊柱畸形 (ASD) 手术的患者进行了单中心病例对照研究。暴露变量包括患者人口统计学、手术变量、影像学测量值和术前 PROMs，包括 Oswestry 残疾指数 (ODI)、数字评分量表背部/腿部疼痛评分 (NRS-Back/Leg) 和 EuroQol-5D (EQ-5D)。主要结局是机械并发症的发生和并发症的发生时间。由于重叠发生，杆断裂和假关节形成被分为一个复合类别。
145 名患者接受了 ASD 手术，并至少随访了 2 年。30/47 (63.8%) 有近端交界性后凸 (PJK) 的患者需要再次手术，而 27/31 (87.1%) 有假关节/杆断裂的患者需要再次手术 (63.8% 比 87.1%，Χ = -0.23，95% CI -0.41，-0.05，p = 0.023)。Cox 回归显示 PJK 和杆断裂/假关节之间的再手术时间无显著差异 (HR = 0.97，95% CI 0.85-1.11，p = 0.686)。远端交界性后凸 (DJK) (N = 3; 2 次再手术) 和植入物失败 (N = 4; 0 次再手术) 很少见。与假关节/杆断裂患者相比，PJK 患者术前的 Hounsfield 单位明显较低 (138.2 ± 43.8 比 160.3 ± 41.0，平均差异 (MD) = -22.1，95% CI -41.8，-2.4，p = 0.028)，先前融合更多 (51.1% 比 25.8%，Χ = 0.253，95% CI 0.41，0.46，p = 0.026)，器械化椎体较少 (9.2 ± 2.6 比 10.7 ± 2.5，MD = -1.5，95% CI -2.7，-0.31，p = 0.013)，术后胸椎后凸 (TK) 更高 (46.3 ± 12.7 比 34.9 ± 10.6，MD = 11.4，95% CI 5.9，16.9，p < 0.001)。更高的术后 C7 矢状垂直轴 (SVA) 没有达到显著差异 (80.7 ± 72.1 比 51.9 ± 57.3，MD = 28.8，95% CI -1.9，59.5，p = 0.066)。术前 PROMs 没有差异。
与 PJK 相比，假关节/杆断裂患者的再手术率更高，但再手术时间相似。此外，与假关节/杆断裂患者相比，PJK 患者术后 TK 更高，Hounsfield 单位较低，先前融合更多，器械化水平更少。这项单中心研究的结果表明，即使机械并发症通常作为一个单一的组进行分析，但它们之间可能存在重要差异。
III。
