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首页> 外文期刊>Neurosurgical focus >Does prior spine surgery or instrumentation affect surgical outcomes following 3-column osteotomy for correction of thoracolumbar deformities?
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Does prior spine surgery or instrumentation affect surgical outcomes following 3-column osteotomy for correction of thoracolumbar deformities?

机译：3柱截骨术矫正胸腰椎畸形后，先前的脊柱外科手术或器械是否会影响手术效果？

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OBJECTIVE Adult spinal deformity (ASD) develops in the setting of asymmetrical arthritic degeneration, and can also be due to iatrogenic causes, such as prior surgery. Many patients who present with ASD have undergone prior spine surgery with instrumentation. Unfortunately, contemporary studies that evaluate the effect of prior surgery or instrumentation on perioperative outcomes, readmission rates, and need for reoperation are lacking. METHODS All ASD patients who underwent a 3-column osteotomy performed by the senior author at the authors’ institution for correction of thoracolumbar spinal deformity between 2006 and 2016 were identified. The authors compared surgical outcomes between primary (first-time) and revision cases. Further subgroup analysis was conducted to investigate the effect of the number of prior surgeries (0, 1, 2, 3, 4, and 5 or more) and the presence of spinal instrumentation on outcomes. Multivariate analysis was used to adjust for relevant and significant confounders. RESULTS A total of 300 patients were included; 38.3% of patients were male. The overall perioperative complication rate was 24.7%, and the mean length of hospitalization was 8.2 days. The 90-day readmission rate was 9.0%, and the overall follow-up reoperation rate was 26.7%. There were no significant differences in complication rates (26.6% vs 24.0%, p = 0.645), length of hospitalization (8.7 vs 7.9 days, p = 0.229), readmission rates (11.4% vs 8.1%, p = 0.387), or reoperation rates (26.6% vs 26.7%, p = 0.984) between primary and revision cases. There was no significant difference in wound complications (infections/dehiscence) requiring reoperation (5.1% vs 6.3%, p = 0.683). Subgroup analysis conducted to evaluate the effect of the number of prior spinal surgeries or the presence of spinal instrumentation did not reveal significant differences for the aforementioned surgical outcomes. In adjusted multivariate analysis, there were no significant associations between history of prior surgery (number of prior surgeries and prior instrumentation) and all of the surgical outcomes of interest. CONCLUSIONS The findings from this study suggest that patients who have undergone prior spine surgery with or without instrumentation are not at increased risk for perioperative complications, need for readmission, or reoperation following 3-column osteotomy of the thoracolumbar spine.
机译：目的成人脊柱畸形（ASD）在非对称性关节炎变性的背景下发展，也可能是由于医源性原因，例如先前的手术。许多患有ASD的患者已经接受了仪器的脊柱手术。不幸的是，缺乏评估先前手术或器械对围手术期结果，再入院率和再次手术需求的影响的当代研究。方法确定所有作者在2006年至2016年间由作者所在机构校正胸腰椎脊柱畸形的3列截骨术ASD患者。作者比较了初次（首次）病例和翻修病例的手术结果。进行了进一步的亚组分析，以调查既往手术次数（0、1、2、3、4和5或更多）的影响以及脊柱器械对结局的影响。多变量分析用于调整相关和重要的混杂因素。结果共纳入300例患者。 38.3％的患者为男性。围手术期总并发症发生率为24.7％，平均住院时间为8.2天。 90天的再次入院率为9.0％，总体随访再手术率为26.7％。并发症发生率（26.6％vs 24.0％，p = 0.645），住院时间（8.7 vs 7.9天，p = 0.229），再入院率（11.4％vs 8.1％，p = 0.387）或再次手术无显着差异。原发和翻修病例之间的比率（26.6％比26.7％，p = 0.984）。需要再次手术的伤口并发症（感染/裂开）没有显着差异（5.1％vs 6.3％，p = 0.683）。进行亚组分析以评估先前的脊柱外科手术的数量或脊柱器械的存在并未发现上述手术结果的显着差异。在调整后的多变量分析中，先前的手术史（先前的手术次数和先前的器械数量）与所有感兴趣的手术结局之间没有显着相关性。结论本研究的结果表明，在接受或不使用器械的情况下接受过脊柱手术的患者，胸腰椎三柱截骨术术后围手术期并发症，再次入院或再次手术的风险均不会增加。

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