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. 2023 May;32(5):1787-1799. doi: 10.1007/s00586-023-07627-2. Epub 2023 Mar 20.
Pan Lumbar Arthodesis (PLA) are often required for Adult Spinal Deformity (ASD) correction, reducing significantly the compensatory capacity in case of postoperative sagittal malalignment. Few papers have investigated outcomes and complications in this vulnerable subset of patients. The objective of this study was to assess revision surgery rate for PLA in ASD, its risk factors and impact on clinical outcomes.
Retrospective multicenter review of prospective ASD data from 7 hospitals covering Europe and Asia. ASD patients included in two prospective databases having a posterior instrumentation spanning the whole lumbar region with more than 2-years of follow-up were reviewed. Demographic, surgical, radiographic parameters and Health-Related Quality of Life (HRQoL) scores were analyzed. Univariate and multivariate regression models analyzed risk factors for revision surgery as well as surgical outcomes. Patients with Early versus Late and PJK versus Non-PJK mechanical complications were also compared.
Out of 1359 ASD patients included in the database 589 (43%) had a PLA and 357 reached 2-years mark. They were analyzed and compared to non-PLA patients. Average age was 67 and 82% were females. 100 Patients (28.1%) needed 114 revision surgeries (75.4% for mechanical failures). Revised patients were more likely to have a nerve system disorder, higher BMI and worst immediate postoperative alignment (as measured by GAP Parameters). These risk factors were also associated with earlier mechanical complications and PJK. Deformity and HRQoL parameters were comparable at baseline. Non-revised patients had significantly better clinical outcomes at 2-years (SRS 22 scores, ODI, Back pain). Multivariate analysis could identify nerve system disorder (OR 4.8; CI 1.8-12.6; p = 0.001), postoperative sagittal alignment (GAP Score) and high BMI (OR 1.07; CI 1.01-1.13; p = 0.004) as independent risk factors for revisions.
Revision surgery due to mechanical failures is relatively common after PLA leading to worse clinical outcomes. Prevention strategies should focus on individualized restoration of sagittal alignment and better weight control to decrease stress on these rigid constructs in non-compliant spines. Nerve system disorders independently increase revision risk in PLA.
Prognosis.
对于成人脊柱畸形（ASD）的矫正，常常需要进行全腰椎融合术（PLA），这显著降低了术后矢状面失平衡的代偿能力。很少有文献研究过这个脆弱亚组患者的结局和并发症。本研究的目的是评估 ASD 中 PLA 的翻修手术率、其危险因素及其对临床结局的影响。
对来自欧洲和亚洲 7 家医院的前瞻性 ASD 数据进行回顾性多中心研究。回顾分析了两个前瞻性数据库中接受了后路器械超过 2 年随访、覆盖整个腰椎区域的 ASD 患者。分析了人口统计学、手术、影像学参数和健康相关生活质量（HRQoL）评分。使用单变量和多变量回归模型分析了翻修手术的危险因素以及手术结果。还比较了早期与晚期、PJK 与非 PJK 机械并发症患者的差异。
在数据库中的 1359 例 ASD 患者中，有 589 例（43%）进行了 PLA，其中 357 例达到 2 年随访时间。对这些患者进行了分析并与非 PLA 患者进行了比较。平均年龄为 67 岁，82%为女性。100 例患者（28.1%）需要进行 114 次翻修手术（75.4%为机械失败）。翻修患者更可能存在神经系统疾病、更高的 BMI 和更差的即刻术后对线（以 GAP 参数测量）。这些危险因素也与更早的机械并发症和 PJK 相关。基线时，畸形和 HRQoL 参数相似。非翻修患者在 2 年时的临床结局明显更好（SRS-22 评分、ODI、腰痛）。多变量分析可以确定神经系统疾病（OR 4.8；95%CI 1.8-12.6；p=0.001）、术后矢状面对线（GAP 评分）和高 BMI（OR 1.07；95%CI 1.01-1.13；p=0.004）是翻修的独立危险因素。
PLA 后因机械失败而进行翻修手术较为常见，这会导致更差的临床结局。预防策略应侧重于个体化恢复矢状面对线，并更好地控制体重，以减少在这些非依从性脊柱中的刚性结构上的压力。神经系统疾病独立增加了 PLA 的翻修风险。
证据水平 II：预后。
