Mills Emily S, Mertz Kevin, Faye Ethan, Bell Jennifer A, Ton Andy T, Wang Jeffrey C, Alluri Ram K, Hah Raymond J
Department of Orthopaedic Surgery, Keck School of Medicine at The University of Southern California, Los Angeles, CA, USA.
Neurospine. 2023 Jun;20(2):662-668. doi: 10.14245/ns.2346222.111. Epub 2023 Jun 30.
The objective of this study is to assess differences in complication profiles between 3-level posterior column osteotomy (PCO) and single-level pedicle subtraction osteotomy (PSO) as both are reported to provide similar degrees of sagittal correction.
The PearlDiver database was queried retrospectively using International Classification of Disease, 9th and 10th edition and Current Procedural Terminology codes to identify patients who underwent PCO or PSO for degenerative spine disease. Patients under age 18 or with history of spinal malignancy, infection, or trauma were excluded. Patients were separated into 2 cohorts, 3-level PCO or single-level PSO, matched at a 1:1 ratio based on age, sex, Elixhauser comorbidity index, and number of fused posterior segments. Thirtyday systemic and procedure-related complications were compared.
Matching resulted in 631 patients for each cohort. PCO patients had decreased odds of respiratory (odds ratio [OR], 0.58; 95% confidence interval [CI], 0.43-0.82; p = 0.001) and renal complications (OR, 0.59; 95% CI, 0.40-0.88; p = 0.009) compared to PSO patients. There was no significant difference in cardiac complications, sepsis, pressure ulcer, dural tear, delirium, neurologic injuries, postoperative hematoma, postoperative anemia, or overall complications.
Patients who undergo 3-level PCO have decreased respiratory and renal complications compared to single-level PSO. No differences were found in the other complications studied. Considering both procedures achieve similar sagittal correction, surgeons should be aware that 3-level PCO offers an improved safety profile compared to single-level PSO.
本研究的目的是评估三级后柱截骨术（PCO）和一级椎弓根截骨术（PSO）之间并发症情况的差异，因为据报道二者能提供相似程度的矢状面矫正。
使用国际疾病分类第9版和第10版以及现行手术操作术语编码对PearlDiver数据库进行回顾性查询，以识别因退行性脊柱疾病接受PCO或PSO手术的患者。排除18岁以下或有脊柱恶性肿瘤、感染或创伤病史的患者。患者按年龄、性别、埃利克斯豪泽合并症指数和融合后段数量以1:1的比例分为两个队列，即三级PCO队列或一级PSO队列。比较30天的全身和手术相关并发症。
每个队列匹配到631例患者。与PSO患者相比，PCO患者发生呼吸系统并发症（优势比[OR]，0.58；95%置信区间[CI]，0.43 - 0.82；p = 0.001）和肾脏并发症（OR，0.59；95% CI，0.40 - 0.88；p = 0.009）的几率降低。在心脏并发症、败血症、压疮、硬脊膜撕裂、谵妄、神经损伤、术后血肿、术后贫血或总体并发症方面无显著差异。
与一级PSO相比，接受三级PCO的患者呼吸系统和肾脏并发症减少。在其他研究的并发症方面未发现差异。考虑到两种手术都能实现相似的矢状面矫正，外科医生应意识到与一级PSO相比，三级PCO具有更好的安全性。
