Outcomes following single-level lumbar fusion in patients with myasthenia gravis

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics Pub Date : 2026-05-01 Epub Date: 2026-02-04 DOI:10.1016/j.jor.2026.02.027

Danielle B. Heckert , Julia Jezykowski , Clare K. Green , Joyce En-Hua Wang , Ved A. Vengsarkar , Wendy Novicoff , Xudong Li , Stephen Lockey

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引用次数: 0

Abstract

Introduction

Patients with myasthenia gravis (MG) are at higher risk for postoperative complications after surgery. Knowledge concerning the impact of the condition on outcomes and complications after spine surgery is currently limited. Using a large-scale, national database, the purpose of this investigation was to compare the rate of medical and surgical complications, healthcare utilization, and need for revision surgery following single-level lumbar fusion between patients with and without MG.

Methods

Data was collected using the PearlDiver database and adult patients with and without MG who underwent single-level lumbar spine fusion from 2010 to 2022 were matched 1:4 on age, sex, and baselin comorbidities. Pearson's Chi-squared test and Welch's t-test were used to evaluate differences in demographic and clinical outcomes. Univariate analysis and multivariate logistic regression were performed to calculate odds ratios (ORs) and 95% confidence intervals (CIs) after controlling for potential confounders.

Results

A total of 537 (20.0%) patients with MG were matched with 2140 (80.0%) patients controls. At 90 days postoperatively, patients with MG experienced significantly higher rates of postoperative arrhythmia, cerebrovascular accident, atelectasis, respiratory failure, pleural effusion, pulmonary embolism, urinary retention, urinary tract infection, and renal failure. At two-year follow up, 27 (5.0%) patients with MG developed pseudoarthrosis compared to 48 (2.2%) controls (OR 2.32; 95% CI: 1.41-3.74; p < 0.001), and 38 (7.1%) MG patients had undergone revision lumbar spine surgery compared to 61 (2.9%) controls (OR: 2.61; 95% CI: 1.70-3.95; p < 0.001). Regarding healthcare utilization, patients with MG were more likely to present to the emergency department and require readmission at both 30 and 90 days postoperatively.

Conclusion

Patients with MG experienced more postoperative complications and higher healthcare utilization after single-level lumbar fusion. These findings highlight the importance of individualized perioperative planning to mitigate risks and inform surgeon counseling of patients and their families.

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重症肌无力患者单节段腰椎融合术的疗效

重症肌无力（MG）患者术后并发症发生率较高。目前关于脊柱手术后病情对预后和并发症的影响的知识有限。使用一个大规模的国家数据库，本研究的目的是比较有MG和无MG患者单节段腰椎融合术后的内科和外科并发症的发生率、医疗保健的利用以及翻修手术的需要。方法使用PearlDiver数据库收集数据，2010年至2022年接受单节段腰椎融合术的成年MG和非MG患者在年龄、性别和基线合并症方面按1:4匹配。使用Pearson卡方检验和Welch t检验来评估人口学和临床结果的差异。在控制潜在混杂因素后，进行单因素分析和多因素logistic回归计算优势比（ORs）和95%置信区间（CIs）。结果537例MG患者（20.0%）与对照组2140例（80.0%）匹配。在术后90天，MG患者出现术后心律失常、脑血管意外、肺不张、呼吸衰竭、胸腔积液、肺栓塞、尿潴留、尿路感染和肾功能衰竭的发生率明显较高。在两年的随访中，27例（5.0%）MG患者发生假关节，而对照组为48例（2.2%）（OR 2.32; 95% CI: 1.41-3.74; p < 0.001）， 38例（7.1%）MG患者接受了腰椎翻修手术，而对照组为61例（2.9%）（OR: 2.61; 95% CI: 1.70-3.95; p < 0.001）。在医疗保健利用方面，MG患者更有可能出现在急诊科，并在术后30天和90天再次入院。结论单节段腰椎融合术后MG患者并发症较多，医疗保健利用率较高。这些发现强调了个体化围手术期计划的重要性，以减轻风险，并告知外科医生对患者及其家属的咨询。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of orthopaedics ORTHOPEDICS-

CiteScore

3.50

自引率

6.70%

发文量

202

审稿时长

56 days

期刊介绍： Journal of Orthopaedics aims to be a leading journal in orthopaedics and contribute towards the improvement of quality of orthopedic health care. The journal publishes original research work and review articles related to different aspects of orthopaedics including Arthroplasty, Arthroscopy, Sports Medicine, Trauma, Spine and Spinal deformities, Pediatric orthopaedics, limb reconstruction procedures, hand surgery, and orthopaedic oncology. It also publishes articles on continuing education, health-related information, case reports and letters to the editor. It is requested to note that the journal has an international readership and all submissions should be aimed at specifying something about the setting in which the work was conducted. Authors must also provide any specific reasons for the research and also provide an elaborate description of the results.