Ekşi Murat Şakir, Tanriverdi Nursena, Topaloğlu Fatma, Duymaz Umut Can, Yeşilyurt Sidar Cenk, Bektaşoğlu Pınar Kuru, Öztürk Özden Çağlar, Börekci Ali, Hazneci Jülide, Topçu Arda, Topal Arif, Hakan Tayfun, Özcan-Ekşi Emel Ece, Çelikoğlu Erhan
FSM Training and Research Hospital, Neurosurgery Clinic, 1/9 İçerenköy-Ataşehir, Istanbul, 34752, Türkiye.
School of Medicine, Department of Neurosurgery, Health Sciences University, Istanbul, Türkiye.
Eur Spine J. 2025 Jan;34(1):215-224. doi: 10.1007/s00586-024-08571-5. Epub 2024 Nov 28.
In the present study, we aimed to analyze whether the Charlson Comorbidity Index (CCI) score was predictive for pseudoarthrosis in patients who underwent with short-segment lumbar decompression and fusion for degenerative lumbar spine disorders (DSD).
Consecutive patients who underwent short-segment lumbar decompression and fusion for DSD between 2013 and 2023 in a tertiary spine clinic were included into the study. Patients' charts were reviewed for patients' comorbidities, smoking status, and the CCI score was calculated accordingly. Subcutaneous fat index (SFI) was used for the anthropometric evaluation of the participants.
Comorbidities/smoking had no significant effect on the pseudoarthrosis rate, when analyzed separately. However, subjects with pseudoarthrosis at their final follow-up visits had significantly higher CCI scores at the pre-operative era compared to the subjects without pseudoarthrosis (p = 0.022). Besides, in patients with pseudoarthrosis and those without pseudoarthrosis 48.1% and 75.3% were overweight according to SFI, respectively (p = 0.003). Multivariable regression analysis depicted ORs of 1.256 (p = 0.018) for the CCI score and 0.269 (p = 0.003) for overweight. The ROC analysis revealed a cut-off value of 2.5 points for the CCI score.
A combined effect of comorbidities might yield higher pseudoarthrosis rates following short-segment decompression and fusion for DSD. Each one-point increment in CCI score and SFI score yielded a 26% increment and a 73% decrement in risk for pseudoarthrosis in those subjects. A cut-off value of 2.5 points for the CCI score could distinguish the subjects who might have pseudoarthrosis following short-segment surgery for DSD.
在本研究中，我们旨在分析在因退行性腰椎疾病（DSD）接受短节段腰椎减压融合术的患者中，查尔森合并症指数（CCI）评分是否可预测假关节形成。
纳入2013年至2023年在一家三级脊柱诊所因DSD接受短节段腰椎减压融合术的连续患者。查阅患者病历以了解其合并症、吸烟状况，并据此计算CCI评分。皮下脂肪指数（SFI）用于对参与者进行人体测量评估。
单独分析时，合并症/吸烟对假关节形成率无显著影响。然而，在末次随访时出现假关节的受试者在术前阶段的CCI评分显著高于未出现假关节的受试者（p = 0.022）。此外，根据SFI，出现假关节的患者和未出现假关节的患者中分别有48.1%和75.3%超重（p = 0.003）。多变量回归分析显示，CCI评分的比值比为1.256（p = 0.018），超重的比值比为0.269（p = 0.003）。ROC分析显示CCI评分的临界值为2.5分。
合并症的综合作用可能导致DSD患者在短节段减压融合术后出现更高的假关节形成率。在这些受试者中，CCI评分每增加1分，假关节形成风险增加26%，SFI评分每增加1分，假关节形成风险降低73%。CCI评分2.5分的临界值可区分DSD患者在短节段手术后可能出现假关节的情况。
