A retrospective analysis of 513 patients undergoing pedicle subtraction osteotomy for adult spinal deformity by a single surgical team: are elderly patients at an elevated risk for complications?

IF 2.9 2区 医学 Q2 CLINICAL NEUROLOGY
Journal of neurosurgery. Spine Pub Date : 2024-09-06 Print Date: 2024-11-01 DOI:10.3171/2024.5.SPINE24105
Ping-Yeh Chiu, Winward Choy, David J Mazur-Hart, Darryl Lau, Jaemin Kim, Terry H Nguyen, Aaron J Clark, Vedat Deviren, Christopher P Ames
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Abstract

Objective: This study aimed to assess whether elderly patients (aged ≥ 70 years) face an elevated risk of complications following pedicle subtraction osteotomy (PSO) for adult spinal deformity (ASD) compared with younger patients (< 70 years) and to evaluate if clinical and radiological outcomes differ between these age groups.

Methods: A retrospective analysis of 513 patients undergoing PSO for ASD by a single surgical team between January 2006 and January 2023 was conducted. Patients were categorized by age (≥ 70 years and < 70 years). Data on clinical, demographic, comorbidity, and radiographic details were collected and compared between the groups. For health-related quality of life assessment, the authors recorded the Oswestry Disability Index (ODI), numeric rating scale (NRS), and Scoliosis Research Society-22 revised (SRS-22r) scores preoperatively and at 6 weeks and 1 year postoperatively. Perioperative complications included major (neurological deficit, death, acute myocardial infarction, stroke), minor (ileus, arrhythmia, delirium), and intraoperative (durotomy, vascular injury).

Results: Of 513 patients, 412 were included in the study. Clinical outcomes, as measured by NRS, ODI, and SRS-22r scores, were comparable between groups, with both groups showing significant improvements postoperatively. Radiographic outcomes also showed significant and comparable improvements in sagittal balance and spinopelvic harmony in both groups. Deformity corrections were also well maintained at 1 year postoperatively. The elderly group (mean age 75.48 years) had a higher rate of perioperative complications (44.64%) than the younger group (mean age 59.60 years; 30.33%) (p = 0.0030), primarily minor complications such as delirium and arrhythmia (16.07% vs 8.61%, p = 0.0279). There was no significant difference between groups regarding the major complication rate (elderly group: 20.83% vs younger group: 14.34%, p = 0.1087), intraoperative complication rate (2.98% vs 3.69%, p = 0.6949), short-term complication rate (10.12% vs 8.20%, p = 0.5024), mechanical complication rate (30.95% vs 32.79%, p = 0.6949), and reoperation rate due to mechanical complications (38.46% vs 43.75% p = 0.5470).

Conclusions: Elderly patients undergoing PSO for ASD experience a higher rate of minor complications but can achieve clinical and radiological outcomes that are comparable to those of younger patients. The authors found no significant increase in major, intraoperative, short-term, or mechanical complication rates and their subsequent reoperation rates among the elderly. These findings underscore the effectiveness of PSO in improving the quality of life for patients with ASD across age groups, emphasizing the critical role of personalized perioperative management in enhancing outcomes and minimizing risks for all patients.

对 513 名接受椎弓根减压截骨术的成人脊柱畸形患者进行回顾性分析:老年患者的并发症风险是否更高?
研究目的本研究旨在评估老年患者(年龄≥70岁)在接受椎弓根减压截骨术(PSO)治疗成人脊柱畸形(ASD)后发生并发症的风险是否高于年轻患者(年龄小于70岁),并评估这些年龄组之间的临床和放射学结果是否存在差异:对2006年1月至2023年1月期间由一个手术团队接受PSO治疗的513名ASD患者进行了回顾性分析。患者按年龄分类(≥ 70 岁和 < 70 岁)。收集了临床、人口统计学、合并症和影像学等方面的详细数据,并对两组患者进行了比较。在健康相关生活质量评估方面,作者记录了术前以及术后6周和1年的Oswestry残疾指数(ODI)、数字评分量表(NRS)和脊柱侧凸研究学会-22修订版(SRS-22r)评分。围手术期并发症包括主要并发症(神经功能缺损、死亡、急性心肌梗死、中风)、轻微并发症(回肠梗阻、心律失常、谵妄)和术中并发症(硬脑膜切开术、血管损伤):在 513 名患者中,有 412 人被纳入研究。以 NRS、ODI 和 SRS-22r 评分衡量,两组患者的临床疗效相当,术后均有显著改善。影像学结果也显示,两组患者在矢状平衡和脊柱骨盆和谐方面都有明显改善,且不相上下。术后一年,畸形矫正效果也保持良好。老年组(平均年龄 75.48 岁)围手术期并发症发生率(44.64%)高于年轻组(平均年龄 59.60 岁;30.33%)(P = 0.0030),主要是谵妄和心律失常等轻微并发症(16.07% vs 8.61%,P = 0.0279)。在主要并发症发生率(老年组:20.83% vs 年轻组:14.34%,P = 0.1087)、术中并发症发生率(2.98% vs 3.69%,P = 0.6949)、短期并发症发生率(10.12% vs 8.20%,P = 0.5024)、机械并发症发生率(30.95% vs 32.79%,P = 0.6949)以及因机械并发症导致的再次手术率(38.46% vs 43.75% P = 0.5470):结论:因 ASD 而接受 PSO 的老年患者发生轻微并发症的比例较高,但其临床和放射学结果可与年轻患者媲美。作者发现,老年患者的主要并发症、术中并发症、短期并发症或机械性并发症发生率及随后的再次手术率均无明显增加。这些发现强调了 PSO 在改善各年龄组 ASD 患者生活质量方面的有效性,强调了个性化围手术期管理在提高所有患者的预后和降低风险方面的关键作用。
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来源期刊
Journal of neurosurgery. Spine
Journal of neurosurgery. Spine 医学-临床神经学
CiteScore
5.10
自引率
10.70%
发文量
396
审稿时长
6 months
期刊介绍: Primarily publish original works in neurosurgery but also include studies in clinical neurophysiology, organic neurology, ophthalmology, radiology, pathology, and molecular biology.
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