Department of Spine Surgery, Hospital for Special Surgery, New York, NY.
Department of Orthopedic Surgery, Lenox Hill Hospital, New York, NY.
Spine (Phila Pa 1976). 2024 Feb 1;49(3):157-164. doi: 10.1097/BRS.0000000000004852. Epub 2023 Oct 17.
Multicenter retrospective cohort study.
To investigate risk factors for loss of correction within the instrumented lumbar spine after adult spinal deformity surgery.
The sustainability of adult spinal deformity surgery remains a health care challenge. Malalignment is a major reason for revision surgery.
A total of 321 patients who underwent fusion of the lumbar spine (≥5 levels, LIV pelvis) with a revision-free follow-up of ≥3 years were identified. Patients were stratified by a change in pelvic incidence-lumbar lordosis from 6 weeks to 3 years postoperative as "maintained" versus "loss" >5°. Those with instrumentation failure (broken rod, screw pullout, etc .) were excluded before comparisons. Demographics, surgical data, and radiographic alignment were compared. Repeated measure analysis of variance was performed to evaluate the maintenance of the correction for L1-L4 and L4-S1. Multivariate logistic regression was conducted to identify independent surgical predictors of correction loss.
The cohort had a mean age of 64 years, a mean Body Mass Index of 28 kg/m 2 , and 80% females. Eighty-two patients (25.5%) lost >5° of pelvic incidence-lumbar lordosis correction (mean loss 10±5°). After the exclusion of patients with instrumentation failure, 52 losses were compared with 222 maintained. Demographics, osteotomies, 3CO, interbody fusion, use of bone morphogenetic protein, rod material, rod diameter, and fusion length were not significantly different. L1-S1 screw orientation angle was 1.3 ± 4.1 from early postoperative to 3 years ( P = 0.031), but not appreciably different at L4-S1 (-0.1 ± 2.9 P = 0.97). Lack of a supplemental rod (odds ratio: 4.0, P = 0.005) and fusion length (odds ratio 2.2, P = 0.004) were associated with loss of correction.
Approximately, a quarter of revision-free patients lose an average of 10° of their 6-week correction by 3 years. Lordosis is lost proximally through the instrumentation ( i.e. tulip/shank angle shifts and/or rod bending). The use of supplemental rods and avoiding sagittal overcorrection may help mitigate this loss.
多中心回顾性队列研究。
探讨成人脊柱畸形手术后器械固定腰椎矫正丢失的危险因素。
成人脊柱畸形手术的可持续性仍然是一个医疗保健挑战。对线不良是翻修手术的主要原因。
共纳入 321 例接受腰椎融合术（≥5 个节段，LIV 骨盆）且无翻修随访≥3 年的患者。根据术后 6 周至 3 年骨盆入射角-腰椎前凸的变化，将患者分为“维持”与“丢失”>5°。在比较之前，排除有器械失败（断棒、螺钉拔出等）的患者。比较患者的人口统计学、手术数据和放射学对线。采用重复测量方差分析评估 L1-L4 和 L4-S1 矫正的维持情况。采用多变量逻辑回归分析确定矫正丢失的独立手术预测因素。
该队列的平均年龄为 64 岁，平均体重指数为 28kg/m2，80%为女性。82 例（25.5%）患者丢失>5°的骨盆入射角-腰椎前凸矫正（平均丢失 10±5°）。排除有器械失败的患者后，52 例丢失与 222 例维持进行比较。患者的人口统计学、截骨术、3CO、椎间融合、使用骨形态发生蛋白、棒材、棒径和融合长度无显著差异。L1-S1 螺钉方向角从术后早期到 3 年为 1.3±4.1°（P=0.031），但在 L4-S1 处差异不明显（-0.1±2.9°，P=0.97）。缺乏补充棒（比值比：4.0，P=0.005）和融合长度（比值比 2.2，P=0.004）与矫正丢失相关。
约四分之一无翻修的患者在 3 年内丢失其 6 周时矫正的平均 10°。通过器械近端丢失前凸（即 tulip/shank 角度移位和/或棒弯曲）。使用补充棒和避免矢状面过度矫正可能有助于减轻这种丢失。
