Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8510, Japan.
Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8510, Japan.
J Clin Neurosci. 2024 Sep;127:110761. doi: 10.1016/j.jocn.2024.110761. Epub 2024 Jul 25.
Despite less invasive surgical procedures in adult spinal deformity (ASD) surgery, some older patients have complications and long recovery time. We investigated patients' willingness to undergo the same surgery again and sought to elucidate the factors related to their perception of surgical outcomes. Enrolled were 60 of our patients (≥65 years old) that underwent long corrective fusion using lateral interbody fusion and who had a minimum of 2 years of follow-up. Patients were asked whether they would theoretically undergo the same surgery again: 28 answered yes (46.7 %; Group-Y), and 32 answered no (53.3 %; Group-N). There was no difference between the groups in age, sex, body mass index, frailty, preoperative patient-reported outcomes (PROs; Oswestry disability index [ODI] and Scoliosis Research Society 22r [SRS-22r]), surgical time, estimated blood loss, or pre-operative and 2-year post-operative radiographic parameters. Major complications had occurred more frequently in Group-N (P = 0.048). Although at 2-year follow-up there was significant improvement of spinal deformity and PROs (P < 0.001) in both groups, PROs in Group-N were inferior (Visual analogue scale [VAS] for low back pain, P = 0.043; VAS for satisfaction, P = 0.001; ODI: P = 0.005; SRS-22r: pain, P = 0.032; self-image, P = 0.014; subtotal, P = 0.005; satisfaction, P < 0.001). After multivariate logistic regression analysis with the willingness to undergo the same surgery again as an objective factor, incidence of major complication was found to be an independently-associated factor in unwillingness to undergo the same surgery again for older patients with ASD if they had the same condition in the future. Avoiding major perioperative complications is important in obtaining satisfactory perception of outcomes in ASD surgery.
尽管成人脊柱畸形 (ASD) 手术的侵袭性较小，但一些老年患者仍会出现并发症和较长的恢复期。我们调查了患者再次接受相同手术的意愿，并试图阐明与他们对手术结果的看法相关的因素。纳入了我们的 60 名患者（年龄≥65 岁），这些患者接受了使用侧方椎间融合的长节段矫正融合，并且至少有 2 年的随访。患者被问及他们是否会从理论上再次接受相同的手术：28 人回答是（46.7%；组 Y），32 人回答否（53.3%；组 N）。两组在年龄、性别、体重指数、脆弱性、术前患者报告的结果（Oswestry 残疾指数 [ODI] 和脊柱侧凸研究协会 22r [SRS-22r]）、手术时间、估计失血量或术前和 2 年术后影像学参数方面没有差异。主要并发症在组 N 中更常见（P=0.048）。尽管在 2 年随访时，两组的脊柱畸形和 PROs 均有显著改善（P<0.001），但组 N 的 PROs 较差（下腰痛视觉模拟评分 [VAS]，P=0.043；满意度 VAS，P=0.001；ODI：P=0.005；SRS-22r：疼痛，P=0.032；自我形象，P=0.014；总分，P=0.005；满意度，P<0.001）。在以再次接受相同手术的意愿为因变量的多变量逻辑回归分析中，发现如果老年 ASD 患者在未来出现相同的情况，发生重大并发症的发生率是他们不愿意再次接受相同手术的独立相关因素。避免围手术期的主要并发症对于获得 ASD 手术结果的满意感知很重要。
