Nilssen Paal K, Narendran Nakul, Skaggs David L, Walker Corey T, Mikhail Christopher M, Nomoto Edward, Tuchman Alexander
Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Eur Spine J. 2025 Mar;34(3):1034-1041. doi: 10.1007/s00586-024-08566-2. Epub 2024 Dec 12.
To perform a large-scale assessment of reoperation risk among spine deformity patients undergoing thoracic to pelvis surgery.
The PearlDiver database was queried for spinal deformity patients (scoliosis, kyphosis, spondylolisthesis, sagittal plane deformity) undergoing at minimum, a T12-pelvis operation (2010-2020). CPT codes identified lumbar arthrodesis procedures that included pelvic fixation and ≥ 7 levels of posterior instrumentation on the same day. Minimum follow-up was 2 years. Reoperations included subsequent arthrodesis, decompression, osteotomy, device insertion, and pelvic fixation procedures. Multivariable regression analysis described associations between variables and reoperation risk.
7,062 patients met criteria. Overall reoperation rate was 23.2%. Reoperation rate at 2- and 5-year was 16.9% and 22.1% respectively. 10-year reoperation-free probability was 73.7% (95% CI: 72.4-74.9%). Multivariable analysis revealed higher reoperation risk for patients with kyphosis and ≥ 13 levels of posterior instrumentation. Patients who received interbody cages had a lower reoperation risk. No association was found between the presence or absence of osteotomy procedures and reoperation risk. Lastly, linear regression analyses revealed no significant relationship between age or ECI and risk for subsequent operations did not independently influence reoperation.
This study, representing a real-world cohort of over six times the largest current prospective data set, found a 2-year reoperation rate of 17%, similar to previous studies, suggesting study group findings are applicable to a broader population. Preoperative kyphosis and ≥ 13 levels of posterior instrumentation was associated with higher reoperation risk, while the use of interbody cages was protective. Age, medical comorbidities, and osteotomies did not predict reoperations.
对接受胸段至骨盆手术的脊柱畸形患者的再次手术风险进行大规模评估。
在PearlDiver数据库中查询接受至少T12 - 骨盆手术（2010 - 2020年）的脊柱畸形患者（脊柱侧凸、后凸、椎体滑脱、矢状面畸形）。CPT编码确定了腰椎融合手术，包括骨盆固定以及同一天≥7节段的后路内固定。最短随访时间为2年。再次手术包括后续的融合、减压、截骨、器械植入和骨盆固定手术。多变量回归分析描述了变量与再次手术风险之间的关联。
7062例患者符合标准。总体再次手术率为23.2%。2年和5年的再次手术率分别为16.9%和22.1%。10年无再次手术概率为73.7%（95%CI：72.4 - 74.9%）。多变量分析显示，后凸患者以及后路内固定≥13节段的患者再次手术风险较高。接受椎间融合器的患者再次手术风险较低。未发现截骨手术的有无与再次手术风险之间存在关联。最后，线性回归分析显示年龄或欧洲校正 Charlson 指数（ECI）与后续手术风险之间无显著关系，且ECI并不能独立影响再次手术。
本研究代表了一个现实世界队列，规模是目前最大的前瞻性数据集的六倍多，发现2年再次手术率为17%，与先前研究相似，表明研究组的结果适用于更广泛的人群。术前存在后凸和后路内固定≥13节段与较高的再次手术风险相关，而使用椎间融合器具有保护作用。年龄、内科合并症和截骨术并不能预测再次手术情况。
