Jamnik Adam A, Datcu Anne-Marie, Lachmann Emily, Patibandla Sahiti D, Thornberg David, Jo Chan-Hee, Morris William Z, Ramo Brandon, Johnson Megan
University of Texas Southwestern, Dallas, TX, USA.
Scottish Rite for Children, Dallas, TX, USA.
Spine Deform. 2024 Jan;12(1):99-107. doi: 10.1007/s43390-023-00742-6. Epub 2023 Aug 12.
Although spinal fusion (SF) is considered "definitive" treatment in juvenile/adolescent idiopathic scoliosis (JIS/AIS), complications requiring reoperation continue to occur. The purpose of this study was to characterize the evolving rates of reoperation following SF in JIS/AIS.
Single-center retrospective review of patients who underwent SF for JIS/AIS as their index surgical treatment between 2013 and 2019. Patient data were collected to identify complications requiring reoperation and factors associated with reoperation. Complication rates from 2013 to 2019 were compared to patients from 1988 to 2012 at the same institution.
This study analyzed 934 patients (81.7% female, mean age at surgery 14.5 ± 2.1). Thirty-eight patients (4.1%) required a total of 47 reoperations, a > 50% decrease in overall complication rate from the 2008-2012 population (4.1% vs 9.6%, respectively, p < 0.001). The decrease stemmed mainly from decreases in rates of infection (1.1% vs 4.1%, p < 0.001) and symptomatic implants (0.4% vs 2.1%, p = 0.004). There were, however, non-significant increases in implant failures (0.6% vs 0.2%, p = 0.4367) and pseudoarthrosis (1.0% vs 0.4%, p = 0.5202). Both of these complications were associated with patients with a higher mean weight (implant failure: 70.4 kg ± 21.1 vs 56.1 kg ± 14.9, p = 0.002; pseudoarthrosis: 85.8 kg ± 27.9 vs 55.9 ± 14.5, p = 0.001).
Reoperation following SF for JIS/AIS has decreased over the past 7 years when compared to 25 years of historical controls. The changing landscape of reoperation demands further research into the risk factors for those reoperations that have become more common.
尽管脊柱融合术（SF）被认为是青少年特发性脊柱侧凸（JIS/AIS）的“确定性”治疗方法，但仍有需要再次手术的并发症不断出现。本研究的目的是描述JIS/AIS患者接受SF治疗后再次手术发生率的变化情况。
对2013年至2019年间因JIS/AIS接受SF作为初次手术治疗的患者进行单中心回顾性研究。收集患者数据以确定需要再次手术的并发症以及与再次手术相关的因素。将2013年至2019年的并发症发生率与同一机构1988年至2012年的患者进行比较。
本研究分析了934例患者（81.7%为女性，手术时平均年龄14.5±2.1岁）。38例患者（4.1%）共需要进行47次再次手术，总体并发症发生率较2008 - 2012年人群降低了>50%（分别为4.1%和9.6%，p<0.001）。下降主要源于感染率（1.1%对4.1%，p<0.001）和有症状植入物发生率（0.4%对2.1%，p = 0.004）的降低。然而，植入物失败率（0.6%对0.2%，p = 0.4367）和假关节形成率（1.0%对0.4%，p = 0.5202）有非显著性增加。这两种并发症均与平均体重较高的患者相关（植入物失败：70.4 kg±21.1对56.1 kg±14.9，p = 0.002；假关节形成：85.8 kg±27.9对55.9±14.5，p = 0.001）。
与25年的历史对照相比，过去7年JIS/AIS患者接受SF治疗后的再次手术率有所下降。再次手术情况的变化需要对那些变得更常见的再次手术的危险因素进行进一步研究。
