Saade Aziz, Tannoury Tony, Bhale Rahul, Singh Varun, Das Avilash, Tannoury Chadi
Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA, USA.
Boston University School of Medicine, Boston, MA, USA.
J Spine Surg. 2024 Sep 23;10(3):438-449. doi: 10.21037/jss-23-127. Epub 2024 Sep 19.
Adult spinal deformities (ASDs) requiring long fusions to the lumbosacral junction are notorious for L5-S1 pseudarthrosis and hardware-related complications. The minimally invasive surgery antepsoas (MIS-ATP) technique allows for substantial anterior column reconstruction thereby reducing the risk of posterior hardware-related complications. This study investigates the incidence of posterior hardware-related complications following long-segment fusion (seven or more vertebrae) using MIS-ATP and posterior percutaneous fixation (PPF).
This is a retrospective review of patients who underwent long spinal fusion (MIS-ATP + PPF) to the sacrum and pelvis for the management of ASD between 2008 and 2019. Postoperative clinical complications and radiographic parameters were collected and analyzed. The following postoperative variables were collected: surgical site infections, neuro-vascular injuries, implant fracture, implant displacement, hardware prominence and related pain, pseudarthrosis, junctional disease (proximal and distal), and need for surgical revision.
A total of 143 patients were included in this study. The most common indications for fusion included: degenerative scoliosis (76.9%) and degenerative spondylolisthesis (17.5%). The average number of fused vertebrae per individual was 8.7. The most common levels fused were: T12-S1 anterior/T10-S1 posterior (53.1%). Forty-four patients (30.8%) experienced a total of 48 complications: pseudarthrosis (2.1%), deep infections (4.2%), painful iliac hardware (5.6%), pedicle screw complications (6.3%), and proximal junctional disease (PJD) (9.8%). Of these, 30 patients (21%) required revision surgery, mostly due to PJD (8 patients; 5.6%).
Long spinal fusions to the sacrum and pelvis are technically challenging and notorious for hardware failure (HF) and revision surgeries. The use of MIS-ATP fusion coupled with PPF could provide a safe and effective strategy against posterior HF. Furthermore, additional benefits of the MIS-ATP technique are inherent to its relatively safe approach-related profile.
需要对腰骶关节进行长节段融合的成人脊柱畸形（ASD）因L5-S1假关节形成和与内固定相关的并发症而声名狼藉。微创腰大肌前路（MIS-ATP）技术可实现实质性的前柱重建，从而降低与后路内固定相关的并发症风险。本研究调查了使用MIS-ATP和后路经皮固定（PPF）进行长节段融合（七个或更多椎体）后与后路内固定相关的并发症发生率。
这是一项对2008年至2019年间因ASD接受腰骶部和骨盆长节段脊柱融合（MIS-ATP + PPF）的患者的回顾性研究。收集并分析术后临床并发症和影像学参数。收集以下术后变量：手术部位感染、神经血管损伤、植入物骨折、植入物移位、内固定物突出及相关疼痛、假关节形成、交界性疾病（近端和远端）以及手术翻修需求。
本研究共纳入143例患者。融合的最常见适应证包括：退变性脊柱侧凸（76.9%）和退变性腰椎滑脱（17.5%）。每位患者融合椎体的平均数量为8.7个。最常见的融合节段为：T12-S1前路/T10-S1后路（53.1%）。44例患者（30.8%）共出现48种并发症：假关节形成（2.1%）、深部感染（4.2%）、髂骨内固定物疼痛（5.6%）、椎弓根螺钉并发症（6.3%）以及近端交界性疾病（PJD）（9.8%）。其中，30例患者（21%）需要进行翻修手术，主要原因是PJD（8例患者；5.6%）。
腰骶部和骨盆的长节段脊柱融合在技术上具有挑战性，并且因内固定失败（HF）和翻修手术而声名狼藉。使用MIS-ATP融合联合PPF可以提供一种安全有效的策略来对抗后路HF。此外，MIS-ATP技术的额外益处源于其相对安全的手术方式相关特点。
