Daher Mohammad, Rasquinha Rhea, Singh Manjot, Nassar Joseph E, Ikwuazom Chibuokem P, Diebo Bassel G, Daniels Alan H
Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, 1 Kettle Point Ave, East Providence, RI, 02914, USA.
Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA.
Spine Deform. 2025 Jan;13(1):49-55. doi: 10.1007/s43390-024-00967-z. Epub 2024 Sep 16.
Surgical management of adolescent idiopathic scoliosis (AIS) and Scheuermann's kyphosis (SK) may be associated with several complications including extended length of stay and unplanned reoperations. Several studies have previously compared postoperative complications and functional outcomes for AIS and SK patients with mixed results. However, a meta-analysis compiling the literature on this topic is lacking.
Following the PRISMA guidelines, PubMed, Cochrane, and Google Scholar (pages 1-20) were accessed and explored until April 2024. The extracted data consisted of complications (overall and surgical-site infections [SSI]), readmissions, reoperations, and Scoliosis Research Society-22 (SRS-22) score. Mean differences (MD) with 95% CI were used for continuous data and odds ratio (OR) was utilized for dichotomous data were calculated across studies.
Seven retrospective articles were included in the meta-analysis, including 4866 patients, with 399 in the SK group and 4467 in the AIS group. SK patients were found to have statistically significantly higher rates of overall complications (OR = 5.41; 95% CI 3.69-7.93, p < .001), SSI (OR = 11.30; 95% CI 6.14-20.82, p < .001), readmissions (OR = 2.81; 95% CI 1.21-6.53, p = 0.02), and reoperations (OR = 7.40; 95% CI 4.76-11.51, p < .001) than AIS patients. However, they had similar SRS-22 scores postoperatively (MD = -0.06; 95% CI -0.16 to 0.04, p = 0.26) despite the SK group having lower SRS-22 scores preoperatively (MD = -0.30; 95% CI -0.42 to -0.18, p < .001).
In this meta-analysis of studies comparing spinal deformity surgery outcomes in AIS and SK patients, SK was associated with more complications, readmissions, and reoperations. SK did have equivalent SRS-22 scores postoperatively to AIS patients, highlighting the benefit of surgical treatment despite higher complication rates. This data may help inform healthcare institutions, payors, and quality monitoring organizations who examine outcomes of pediatric and adult spinal deformity surgery.
青少年特发性脊柱侧凸（AIS）和休门氏驼背（SK）的手术治疗可能会引发多种并发症，包括住院时间延长和意外再次手术。此前已有多项研究比较了AIS和SK患者的术后并发症及功能结局，但结果不一。然而，目前尚缺乏针对该主题的文献荟萃分析。
按照PRISMA指南，检索了PubMed、Cochrane和谷歌学术（第1 - 20页），直至2024年4月。提取的数据包括并发症（总体并发症和手术部位感染[SSI]）、再次入院、再次手术以及脊柱侧凸研究学会-22（SRS-22）评分。各研究间针对连续性数据计算了95%置信区间的平均差（MD），针对二分数据计算了比值比（OR）。
该荟萃分析纳入了7篇回顾性文章，共4866例患者，其中SK组399例，AIS组4467例。结果发现，SK患者的总体并发症发生率（OR = 5.41；95% CI 3.69 - 7.93，p <.001）、SSI发生率（OR = 11.30；95% CI 6.14 - 20.82，p <.001）、再次入院率（OR = 2.81；95% CI 1.21 - 6.53，p = 0.02）和再次手术率（OR = 7.40；95% CI 4.76 - 11.51，p <.001）均显著高于AIS患者。然而，尽管SK组术前SRS-22评分较低（MD = -0.30；95% CI -0.42至-0.18，p <.001），但其术后SRS-22评分与AIS患者相似（MD = -0.06；95% CI -0.16至0.04，p = 0.26）。
在这项比较AIS和SK患者脊柱畸形手术结局的研究荟萃分析中，SK与更多的并发症、再次入院和再次手术相关。尽管SK并发症发生率较高，但其术后SRS-22评分与AIS患者相当，凸显了手术治疗的益处。这些数据可能有助于为审查儿童和成人脊柱畸形手术结局的医疗机构、支付方及质量监测组织提供参考。
