Seidel Henry D, Benson Dillon, Litvak Audrey, Lee Michael, El Dafrawy Mostafa
University of Chicago, Pritzker School of Medicine, Chicago, IL, United States.
University of Chicago, Department of Orthopaedics and Rehabilitation Medicine, Chicago, IL, United States.
N Am Spine Soc J. 2024 Dec 19;21:100577. doi: 10.1016/j.xnsj.2024.100577. eCollection 2025 Mar.
HIV has been associated with cervical myelopathy, but it is unclear if HIV leads to earlier presentation of DCM and need for decompression surgery. Furthermore, long-term rates of postoperative complications and revision following decompression surgery have not been investigated in this patient population. The aim of this study was to identify the age of surgery for degenerative cervical myelopathy (DCM) in patients with human immunodeficiency virus (HIV) and investigate postoperative revision and complication rates.
Patients who underwent decompression surgery for DCM were identified in a national database and stratified by preexisting diagnosis of HIV. Demographic characteristics were identified. The 2-year rates of revision surgery, 2-year rates of postoperative surgical complications, and 90-day rates of postoperative medical complications were calculated.
1,014 patients with HIV and 153,974 patients without HIV were identified. The HIV group was younger at the time of decompression (53.6 ± 8.8; Non-HIV: 57.1 ± 11.0; p.0001). There were no statistically significant differences in 2-year rates of revision (HIV: 7.6 %; Non-HIV 7.72 %; p=.88), removal of implants (HIV: 0.99 %; Non-HIV 1.06 %; p=.82), or I&D (HIV: 1.78 %; Non-HIV 1.31 %; p=.19). There were significant differences in the 2-year rates of infection diagnosis (HIV 4.93 %, non-HIV 3.59 %; p=.022) and neurological deficit (HIV 6.02 %, non-HIV 4.20 %; p<.001). 90-day medical complications of pneumonia, UTI, and renal failure were higher in the HIV group.
Patients with HIV who develop cervical myelopathy undergo decompression at a younger age; this age difference may not be clinically significant. While patients with HIV are more likely to have higher rates of short-term medical complications, they do not experience higher 2-year rates of revision or surgical complications requiring reoperation.
HIV与颈髓病有关，但尚不清楚HIV是否会导致退行性颈椎病（DCM）更早出现以及是否需要减压手术。此外，尚未对该患者群体减压手术后的长期并发症发生率和翻修率进行研究。本研究的目的是确定人类免疫缺陷病毒（HIV）患者退行性颈椎病（DCM）的手术年龄，并调查术后翻修率和并发症发生率。
在一个国家数据库中识别接受DCM减压手术的患者，并根据是否预先诊断为HIV进行分层。确定人口统计学特征。计算翻修手术的2年发生率、术后手术并发症的2年发生率和术后医疗并发症的90天发生率。
共识别出1014例HIV患者和153974例非HIV患者。HIV组减压时年龄较小（53.6±8.8岁；非HIV组：57.1±11.0岁；p<0.0001）。2年翻修率（HIV组：7.6%；非HIV组7.72%；p = 0.88）、植入物取出率（HIV组：0.99%；非HIV组1.06%；p = 0.82）或切开引流率（HIV组：1.78%；非HIV组1.31%；p = 0.19）无统计学显著差异。2年感染诊断率（HIV组4.93%，非HIV组3.59%；p = 0.022）和神经功能缺损率（HIV组6.02%，非HIV组4.20%；p<0.001）有显著差异。HIV组肺炎、尿路感染和肾衰竭的90天医疗并发症发生率较高。
发生颈髓病的HIV患者减压手术年龄较小；这种年龄差异可能无临床意义。虽然HIV患者短期医疗并发症发生率较高，但他们2年的翻修率或需要再次手术的手术并发症发生率并不高。
