重度脊柱畸形手术中神经并发症的危险因素

Risk Factors for Neurological Complications in Severe Spinal Deformity Surgery.

作者信息

Wang Xinwei, Zhang Haoran, Li Chenkai, Ye Xiaohan, Zhao Yiwei, Du You, Wang Shengru, Zhang Jianguo

机构信息

Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.

出版信息

Orthop Surg. 2025 Oct;17(10):2914-2926. doi: 10.1111/os.70158. Epub 2025 Sep 2.

DOI:10.1111/os.70158

PMID:40898679

Abstract

OBJECTIVE

Severe spinal deformities, including scoliosis and kyphosis, present significant challenges in corrective surgery due to the elevated risk of neurological complications. The identification of preoperative risk factors is of paramount importance for the optimization of outcomes and the prevention of complications.

METHODS

This retrospective cohort study analyzed 130 patients with severe spinal deformities who underwent surgical treatments from January 2002 to May 2022. A comprehensive collection and analysis of preoperative clinical, imaging, and surgical data were conducted with the objective of identifying risk factors for neurological complications. Univariate and multivariate logistic regression analyses were conducted to ascertain the independent predictors.

RESULTS

A total of 130 patients were included in the study, with a female ratio of 50% and a mean age of 21.4 ± 15.3 years, and 18 (13.8%) of them experienced postoperative neurological complications. Significant factors included preoperative spinal cord anomalies (38.9% in the complication group vs. 8.9% in the non-complication group, p = 0.001) and a higher kyphosis angle (112.4° in the complication group vs. 98.2° in the non-complication group, p = 0.018). The incidence of intraoperative neuromonitoring alarms was significantly higher in the complication group (38.9% vs. 15.9%, p = 0.022). No significant differences were observed in operative time (p = 0.095) or blood loss (p = 0.179). A higher angle of kyphosis (OR = 1.027, 95% CI: 1.001-1.055, p = 0.045) and the occurrence of spinal cord anomalies (OR = 6.715, 95% CI: 1.694-26.615, p = 0.007) were independent predictors of surgical neurological complications.

CONCLUSIONS

Preoperative spinal cord anomalies and a higher kyphosis angle are independent risk factors for postoperative neurological complications. A comprehensive preoperative evaluation is essential for optimizing surgical strategies in these high-risk patients.

摘要

目的

严重脊柱畸形，包括脊柱侧凸和后凸，由于神经并发症风险升高，在矫正手术中带来重大挑战。识别术前风险因素对于优化手术结果和预防并发症至关重要。

方法

这项回顾性队列研究分析了2002年1月至2022年5月期间接受手术治疗的130例严重脊柱畸形患者。对术前临床、影像学和手术数据进行了全面收集和分析，目的是识别神经并发症的风险因素。进行单因素和多因素逻辑回归分析以确定独立预测因素。

结果

该研究共纳入130例患者，女性占比50%，平均年龄21.4±15.3岁，其中18例（13.8%）出现术后神经并发症。显著因素包括术前脊髓异常（并发症组为38.9%，非并发症组为8.9%，p = 0.001）和更高的后凸角度（并发症组为112.4°，非并发症组为98.2°，p = 0.018）。并发症组术中神经监测警报的发生率显著更高（38.9%对15.9%，p = 0.022）。手术时间（p = 0.095）或失血量（p = 0.179）未观察到显著差异。更高的后凸角度（OR = 1.027，95%CI：1.001 - 1.055，p = 0.045）和脊髓异常的发生（OR = 6.715，95%CI：1.694 - 26.615，p = 0.007）是手术神经并发症的独立预测因素。