Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany.
Acta Neurochir (Wien). 2023 May;165(5):1145-1154. doi: 10.1007/s00701-023-05566-x. Epub 2023 Mar 30.
Surgical intervention for management of spinal instability after traumatic subaxial fractures in octogenarians requires a clear consensus on optimal treatments. This study aimed to provide a guide for more efficient management through comparison and assessment of clinical outcomes and complications of anterior cervical discectomy and fusion with plate (pACDF) and posterior decompression fusion (PDF) instrumentation alone in patients aged 80 years.
A single institution retrospective review of electronic medical records was undertaken between September 2005 and December 2021. Comorbidities were assessed using the age-adjusted Charlson comorbidity index (CCI). Logistic regression was used to identify potential risk factors for ACDF complications.
The rate of comorbidities were similarly high between the pACDF (n=13) and PDF (n=15) groups (pACDF: 8.7 ± 2.4 points vs. 8.5 ± 2.3 points; p=0.555). Patients in the PDF group had significantly longer surgical duration (235 ± 58.4 min vs. 182.5 ± 32.1 min; p<0.001) and significantly higher volumes of intraoperative blood loss (661.5 ± 100.1 mL vs. 487.5 ± 92.1 mL; p<0.001). The in-hospital mortality was 7.7% for the pACDF group and 6.7% for the PDF group. On day 90, the mortality rate increased in both groups from baseline (pACDF: 15.4% vs. PDF: 13.3; p>0.05). Motor scores (MS) improved significantly after surgery in both groups (pACDF: preOP MS: 75.3 ± 11.1 vs. postOP MS: 82.4 ± 10.1; p<0.05; PDF: preOP MS: 80.7 ± 16.7 vs. postOP MS: 89.5 ± 12.1; p<0.05). Statistically significant predictors for postoperative complications included longer operative times (odds ratio 1.2, 95% confidence interval 1.1-2.1; p=0.005) and larger volume of blood loss (odds ratio 1.5, 95% confidence interval 1.2-2.2; p=0.003).
Both pACDF and PDF can be considered safe treatment strategies for octogenarians with a poor baseline profile and subaxial fractures as they lead to patients substantial neurological improvements, and they are accompanied with low morbidity and mortality rates. Operation duration and intraoperative blood loss should be minimized to increase the degree of neurological recovery in octogenarian patients.
对于 80 岁以上老年人创伤性下颈椎骨折后脊柱不稳定的手术干预，需要就最佳治疗方法达成明确共识。本研究旨在通过比较和评估单独使用前路颈椎间盘切除融合术伴钢板（pACDF）和后路减压融合术（PDF）治疗 80 岁以上患者的临床结果和并发症，为更有效的管理提供指导。
对 2005 年 9 月至 2021 年 12 月期间的电子病历进行单中心回顾性分析。使用年龄调整 Charlson 合并症指数（CCI）评估合并症。使用逻辑回归确定 ACDF 并发症的潜在危险因素。
pACDF 组（n=13）和 PDF 组（n=15）的合并症发生率相似（pACDF：8.7±2.4 分 vs. 8.5±2.3 分；p=0.555）。PDF 组的手术时间明显更长（235±58.4 分钟 vs. 182.5±32.1 分钟；p<0.001），术中出血量明显更多（661.5±100.1 毫升 vs. 487.5±92.1 毫升；p<0.001）。pACDF 组的院内死亡率为 7.7%，PDF 组为 6.7%。90 天时，两组的死亡率均较基线时升高（pACDF：15.4% vs. PDF：13.3%；p>0.05）。两组术后运动评分（MS）均显著改善（pACDF：术前 MS：75.3±11.1 分 vs. 术后 MS：82.4±10.1 分；p<0.05；PDF：术前 MS：80.7±16.7 分 vs. 术后 MS：89.5±12.1 分；p<0.05）。术后并发症的统计学显著预测因素包括手术时间延长（优势比 1.2，95%置信区间 1.1-2.1；p=0.005）和出血量增加（优势比 1.5，95%置信区间 1.2-2.2；p=0.003）。
pACDF 和 PDF 均可作为基线较差的下颈椎骨折 80 岁以上老年人的安全治疗策略，因为它们能使患者的神经功能显著改善，同时伴有较低的发病率和死亡率。对于 80 岁以上的患者，应尽量减少手术时间和术中出血量，以提高患者的神经恢复程度。
