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首页> 外文期刊>Neurosurgical focus >Evaluation of complications and neurological deficits with three-column spine reconstructions for complex spinal deformity: A retrospective Scoli-RISK-1 study
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Evaluation of complications and neurological deficits with three-column spine reconstructions for complex spinal deformity: A retrospective Scoli-RISK-1 study

机译：三柱脊柱重建术治疗复杂性脊柱畸形的并发症和神经功能缺损的评估：回顾性Scoli-RISK-1研究

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Object: The goal in this study was to evaluate the risk factors for complications, including new neurological deficits, in the largest cohort of patients with adult spinal deformity to date. Methods: The Scoli-RISK-1 inclusion criteria were used to identify eligible patients from 5 centers who were treated between June 1, 2009, and June 1, 2011. Records were reviewed for patient demographic information, surgical data, and reports of perioperative complications. Neurological deficits were recorded as preexisting or as new deficits. Patients who underwent 3-column osteotomies (3COs) were compared with those who did not (posterior spinal fusion [PSF]). Between-group comparisons were performed using independent samples t-tests and chi-square analyses. Results: Two hundred seven patients were identified-75 who underwent PSF and 132 treated with 3CO. In the latter group, patients were older (58.9 vs 49.4 years, p < 0.001), had a higher body mass index (29.0 vs 25.8, p b= 0.029), smaller preoperative coronal Cobb measurements (33.8° vs 56.4°, p < 0.001), more preoperative sagittal malalignment (11.7 cm vs 5.4 cm, p < 0.001), and similar sagittal Cobb measurements (45.8° vs 57.7°, p = 0.113). Operating times were similar (393 vs 423 minutes, p = 0.130), although patients in the 3CO group sustained higher estimated blood loss (2120 vs 1700 ml, p = 0.066). Rates of new neurological deficits were similar (PSF: 6.7% vs 3CO: 9.9%, p = 0.389), and rates of any perioperative medical complication were similar (PSF: 46.7% vs 3CO: 50.8%, p = 0.571). Patients who underwent vertebral column resection (VCR) were more likely to sustain medical complications than those treated with pedicle subtraction osteotomy (73.7% vs 46.9%, p = 0.031), although new neurological deficits were similar (15.8% vs 8.8%, p = 0.348). Regression analysis did not reveal significant predictors of neurological injury or complication from collected data. Conclusions: Despite higher estimated blood loss, rates of all complications (49.3%) and new neurological deficits (8.7%) did not vary for patients who underwent complex reconstruction, whether or not a 3CO was performed. Patients who underwent VCR sustained more medical complications without an increase in new neurological deficits. Prospective studies of patient factors, provider factors, and refined surgical data are needed to define and optimize risk factors for complication and neurological deficits
机译：目的：本研究的目的是评估迄今为止最大的成人脊柱畸形患者队列中并发症的危险因素，包括新的神经功能缺损。方法：采用Scoli-RISK-1纳入标准，从2009年6月1日至2011年6月1日对5个中心的合格患者进行鉴定。对患者的人口统计学信息，手术数据以及围手术期并发症的报告进行了回顾。神经功能缺损被记录为既往或新的缺损。将接受3列截骨术（3CO）的患者与未进行3列截骨术的患者（后路脊柱融合术[PSF]）进行比较。组间比较使用独立样本t检验和卡方分析进行。结果：鉴定出207例患者，其中75例行了PSF，132例行了3CO治疗。在后一组中，患者年龄较大（58.9 vs 49.4岁，p <0.001），体重指数较高（29.0 vs 25.8，pb = 0.029），术前冠状Cobb测量值较小（33.8°vs 56.4°，p <0.001） ），更多的术前矢状位错位（11.7 cm vs 5.4 cm，p <0.001），以及相似的矢状Cobb测量值（45.8°vs 57.7°，p = 0.113）。手术时间相似（393 vs 423分钟，p = 0.130），尽管3CO组患者的失血量估计更高（2120 vs 1700 ml，p = 0.066）。新的神经功能缺损的发生率相似（PSF：6.7％vs 3CO：9.9％，p = 0.389），任何围手术期并发症的发生率也相似（PSF：46.7％vs 3CO：50.8％，p = 0.571）。椎弓根切除术（VCR）的患者比经椎弓根截骨术的患者更有可能承受医疗并发症（73.7％vs 46.9％，p = 0.031），尽管新的神经功能缺损相似（15.8％vs 8.8％，p = 0.348）。回归分析并未从收集的数据中揭示出神经损伤或并发症的重要预测指标。结论：尽管估计失血量更高，但是无论是否进行了3CO重建，所有并发症的发生率（49.3％）和新的神经功能缺损（8.7％）均没有变化。接受VCR的患者在不增加新的神经功能缺损的情况下，仍承受着更多的医疗并发症。需要对患者因素，提供者因素和完善的手术数据进行前瞻性研究，以定义和优化并发症和神经功能缺损的危险因素

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