Ragborg Lærke C, Dragsted Casper, Hallager Dennis W, Dahl Benny, Gehrchen Martin
Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen, DNK.
Cureus. 2024 Sep 23;16(9):e70020. doi: 10.7759/cureus.70020. eCollection 2024 Sep.
Aim We aim to assess the long-term revision rates in patients with adult spinal deformity (ASD) undergoing posterior instrumentation with or without supplemental anterior lumbar interbody fusion (ALIF) with a median of eight years of follow-up. Materials and methods Based on a previous pilot randomized controlled trial (RCT) from 2012, all previous participants were invited to a clinical and radiographic follow-up. Full medical records from the total cohort were reviewed from the time of operation to the follow-up, and information on revision surgery due to mechanical failure was obtained and compared between the groups. Results Of the original 17 patients included in the RCT, 15 were available for follow-up and 10 attended the clinical and radiographic examination. A retrospective review was performed of the entire original cohort. The median age at follow-up was 67 (61-71) years, and the median follow-up time was 7.7 (5.1-8.8) years. Revision rates among ALIF patients were three out of seven (43%) and eight out of 10 (80%) among non-ALIF patients with pseudoarthrosis and rod breakage being the main cause. Time to failure was longer in ALIF patients with a median of 47 (28-53) months compared with non-ALIF patients with a median of 26 (9-31) months. Conclusion This study revealed a lower rate of revision surgery and a longer time to failure in patients undergoing ASD surgery with supplemental ALIF compared with posterior instrumentation alone. Further studies with a larger sample size are needed to make conclusions on the effect of a supplemental ALIF to posterior instrumentation on lowering the risk of mechanical failure in patients with adult spinal deformity.
目的 我们旨在评估接受后路内固定术（无论是否辅以腰椎前路椎间融合术[ALIF]）的成人脊柱畸形（ASD）患者的长期翻修率，随访时间中位数为8年。材料与方法 基于2012年之前的一项初步随机对照试验（RCT），邀请所有之前的参与者进行临床和影像学随访。回顾了整个队列从手术到随访时的完整病历，获取了因机械故障进行翻修手术的信息，并在组间进行比较。结果 在RCT纳入的最初17例患者中，15例可供随访，10例参加了临床和影像学检查。对整个原始队列进行了回顾性分析。随访时的年龄中位数为67（61 - 71）岁，随访时间中位数为7.7（5.1 - 8.8）年。ALIF患者的翻修率为7例中的3例（43%），非ALIF患者为10例中的8例（80%），假关节形成和棒材断裂是主要原因。ALIF患者的失效时间更长，中位数为47（28 - 53）个月，而非ALIF患者的中位数为26（9 - 31）个月。结论 本研究表明，与单纯后路内固定术相比，接受ASD手术并辅以ALIF的患者翻修手术率更低，失效时间更长。需要进一步进行更大样本量的研究，以得出关于辅以ALIF的后路内固定术对降低成人脊柱畸形患者机械故障风险的效果的结论。
