Department of Orthopedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN, 55454, USA.
Department of Neurological Surgery, Vanderbilt University, Nashville, TN, 37204, USA.
Eur Spine J. 2024 Jul;33(7):2751-2762. doi: 10.1007/s00586-024-08241-6. Epub 2024 Apr 15.
Despite modern fixation techniques, spinopelvic fixation failure (SPFF) after adult spinal deformity (ASD) surgery ranges from 4.5 to 38.0%, with approximately 50% requiring reoperation. Compared to other well-studied complications after ASD surgery, less is known about the incidence and predictors of SPFF.
AIMS/OBJECTIVES: Given the high rates of SPFF and reoperation needed to treat it, the purpose of this systematic review and meta-analysis was to report the incidence and failure mechanisms of SPF after ASD surgery.
MATERIALS/METHODS: The literature search was executed across four databases: Medline via PubMed and Ovid, SPORTDiscus via EBSCO, Cochrane Library via Wiley, and Scopus. Study inclusion criteria were patients undergoing ASD surgery with spinopelvic instrumentation, report rates of SPFF and type of failure mechanism, patients over 18 years of age, minimum 1-year follow-up, and cohort or case-control studies. From each study, we collected general demographic information (age, gender, and body mass index), primary/revision, type of ASD, and mode of failure (screw loosening, rod breakage, pseudarthrosis, screw failure, SI joint pain, screw protrusion, set plug dislodgment, and sacral fracture) and recorded the overall rate of SPF as well as failure rate for each type. For the assessment of failure rate, we required a minimum of 12 months follow-up with radiographic assessment.
Of 206 studies queried, 14 met inclusion criteria comprising 3570 ASD patients who underwent ASD surgery with pelvic instrumentation (mean age 65.5 ± 3.6 years). The mean SPFF rate was 22.1% (range 3-41%). Stratification for type of failure resulted in a mean SPFF rate of 23.3% for the pseudarthrosis group; 16.5% for the rod fracture group; 13.5% for the iliac screw loosening group; 7.3% for the SIJ pain group; 6.1% for the iliac screw group; 3.6% for the set plug dislodgement group; 1.1% for the sacral fracture group; and 1% for the iliac screw prominence group.
The aggregate rate of SPFF after ASD surgery is 22.1%. The most common mechanisms of failure were pseudarthrosis, rod fracture, and iliac screw loosening. Studies of SPFF remain heterogeneous, and a consistent definition of what constitutes SPFF is needed. This study may enable surgeons to provide patient specific constructs with pelvic fixation constructs to minimize this risk of failure.
尽管采用了现代固定技术，成人脊柱畸形（ASD）手术后的脊柱骨盆固定失败（SPFF）仍在 4.5%至 38.0%之间，约有 50%需要再次手术。与 ASD 手术后其他研究充分的并发症相比，SPFF 的发生率和预测因素知之甚少。
目的/目标：鉴于 SPFF 的发生率高，且需要进行再次手术来治疗，本系统评价和荟萃分析的目的是报告 ASD 手术后 SPF 的发生率和失败机制。
材料/方法：文献检索在四个数据库中进行：Medline 通过 PubMed 和 Ovid、SPORTDiscus 通过 EBSCO、Cochrane Library 通过 Wiley 和 Scopus。研究纳入标准为接受 ASD 手术和脊柱骨盆器械固定的患者，报告 SPFF 发生率和失败机制类型，患者年龄大于 18 岁，至少 1 年随访，以及队列或病例对照研究。从每项研究中，我们收集了一般人口统计学信息（年龄、性别和体重指数）、原发性/复发性、ASD 类型和失败模式（螺钉松动、棒断裂、假关节、螺钉失败、SI 关节疼痛、螺钉突出、固定塞脱落和骶骨骨折），并记录了 SPF 的总体发生率以及每种类型的失败率。对于失败率评估，我们要求至少有 12 个月的影像学随访。
在查询的 206 项研究中，有 14 项符合纳入标准，共纳入 3570 例接受 ASD 手术和骨盆器械固定的 ASD 患者（平均年龄 65.5 ± 3.6 岁）。SPFF 发生率的平均为 22.1%（范围 3-41%）。根据失败类型分层，假关节组的平均 SPFF 发生率为 23.3%；棒断裂组为 16.5%；髂骨螺钉松动组为 13.5%；SIJ 疼痛组为 7.3%；髂骨螺钉组为 6.1%；固定塞脱落组为 3.6%；骶骨骨折组为 1.1%；髂骨螺钉突出组为 1%。
ASD 手术后 SPFF 的总体发生率为 22.1%。最常见的失败机制是假关节、棒断裂和髂骨螺钉松动。SPFF 的研究仍然存在异质性，需要对什么是 SPFF 有一个统一的定义。本研究可以使外科医生为患者提供具有骨盆固定结构的特定构建，以最大限度地降低这种失败风险。
