Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA.
Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
Eur Spine J. 2024 May;33(5):2049-2055. doi: 10.1007/s00586-024-08184-y. Epub 2024 Mar 13.
Abdominal aortic calcification (AAC), often found incidentally on lateral lumbar radiographs, is increasingly recognized for its association with adverse outcomes in spine surgery. As a marker of advanced atherosclerosis affecting cardiovascular dynamics, this study evaluates AAC's impact on perioperative blood loss in posterior spinal fusion (PSF).
Patients undergoing PSF from March 2016 to July 2023 were included. Estimated blood loss (EBL) and total blood volume (TBV) were calculated. AAC was assessed on lateral lumbar radiographs according to the Kauppila classification. Predictors of the EBL-to-TBV ratio (%EBL/TBV) were examined via univariable and multivariable regression analyses, which adjusted for parameters such as hypertension and aspirin use.
A total of 199 patients (47.2% female) were analyzed. AAC was present in 106 patients (53.3%). AAC independently predicted %EBL/TBV, accounting for an increase in blood loss of 4.46% of TBV (95% CI 1.17-7.74, p = 0.008).
This is the first study to identify AAC as an independent predictor of perioperative blood loss in PSF. In addition to its link to degenerative spinal conditions and adverse postoperative outcomes, the relationship between AAC and increased blood loss warrants attention in patients undergoing PSF.
在侧位腰椎 X 光片上偶然发现的腹主动脉钙化（AAC），由于与脊柱手术的不良结果相关，其相关性越来越受到重视。作为影响心血管动力学的晚期动脉粥样硬化的标志物，本研究评估 AAC 对后路脊柱融合术（PSF）围手术期失血的影响。
纳入 2016 年 3 月至 2023 年 7 月期间接受 PSF 的患者。计算估计失血量（EBL）和总血容量（TBV）。根据 Kauppila 分类，在侧位腰椎 X 光片上评估 AAC。通过单变量和多变量回归分析检查 EBL 与 TBV 比值（%EBL/TBV）的预测因素，这些因素调整了高血压和阿司匹林使用等参数。
共分析了 199 名患者（47.2%为女性）。106 名患者（53.3%）存在 AAC。AAC 独立预测%EBL/TBV，使 TBV 的失血量增加 4.46%（95%CI 1.17-7.74，p=0.008）。
这是第一项确定 AAC 是 PSF 围手术期失血的独立预测因素的研究。除了与退行性脊柱疾病和不良术后结果有关外，AAC 与失血增加之间的关系值得在接受 PSF 的患者中引起关注。
