Abstract：
OBJECTIVE: Adult spinal deformity is a complex pathology that benefits greatly from surgical treatment. Despite continuous innovation, little is known regarding continuous changes in surgical techniques and the complications rate. The objective of the current study was to investigate the evolution of the patient profiles and surgical complications across a single prospective multicenter database.
METHODS: This study is a retrospective review of a prospective, multicenter database of surgically treated patients with adult spinal deformity (thoracic kyphosis > 60°, sagittal vertical axis > 5 cm, pelvic tilt > 25°, or Cobb angle > 20°) with a minimum 2-year follow-up. Patients were stratified into 3 equal groups by date of surgery. The three groups\' demographic data, preoperative data, surgical information, and complications were then compared. A moving average of 320 patients was used to visualize and investigate the evolution of the complication across the enrollment period.
RESULTS: A total of 928/1260 (73.7%) patients completed their 2-year follow-up, with an enrollment rate of 7.7 ± 4.1 patients per month. Across the enrollment period (2008-2018) patients became older (mean age increased from 56.7 to 64.3 years) and sicker (median Charlson Comorbidity Index rose from 1.46 to 2.08), with more pure sagittal deformity (type N). Changes in surgical treatment included an increased use of interbody fusion, more anterior column release, and a decrease in the 3-column osteotomy rate, shorter fusion, and more supplemental rods and bone morphogenetic protein use. There was a significant decrease in major complications associated with a reoperation (from 27.4% to 17.1%) driven by a decrease in radiographic failures (from 12.3% to 5.2%), despite a small increase in neurological complications. The overall complication rate has decreased over time, with the lowest rate of any complication (51.8%) during the period from August 2014 to March 2017. Major complications associated with reoperation decreased rapidly in the 2014-2015. Major complications not associated with reoperation had the lowest level (21.0%) between February 2014 and October 2016.
CONCLUSIONS: Despite an increase in complexity of cases, complication rates did not increase and the rate of complications leading to reoperation decreased. These improvements reflect the changes in practice (supplemental rod, proximal junctional kyphosis prophylaxis, bone morphogenetic protein use, anterior correction) to ensure maintenance of status or improved outcomes.
METHODS: This study is a retrospective review of a prospective, multicenter database of surgically treated patients with adult spinal deformity (thoracic kyphosis > 60°, sagittal vertical axis > 5 cm, pelvic tilt > 25°, or Cobb angle > 20°) with a minimum 2-year follow-up. Patients were stratified into 3 equal groups by date of surgery. The three groups\' demographic data, preoperative data, surgical information, and complications were then compared. A moving average of 320 patients was used to visualize and investigate the evolution of the complication across the enrollment period.
RESULTS: A total of 928/1260 (73.7%) patients completed their 2-year follow-up, with an enrollment rate of 7.7 ± 4.1 patients per month. Across the enrollment period (2008-2018) patients became older (mean age increased from 56.7 to 64.3 years) and sicker (median Charlson Comorbidity Index rose from 1.46 to 2.08), with more pure sagittal deformity (type N). Changes in surgical treatment included an increased use of interbody fusion, more anterior column release, and a decrease in the 3-column osteotomy rate, shorter fusion, and more supplemental rods and bone morphogenetic protein use. There was a significant decrease in major complications associated with a reoperation (from 27.4% to 17.1%) driven by a decrease in radiographic failures (from 12.3% to 5.2%), despite a small increase in neurological complications. The overall complication rate has decreased over time, with the lowest rate of any complication (51.8%) during the period from August 2014 to March 2017. Major complications associated with reoperation decreased rapidly in the 2014-2015. Major complications not associated with reoperation had the lowest level (21.0%) between February 2014 and October 2016.
CONCLUSIONS: Despite an increase in complexity of cases, complication rates did not increase and the rate of complications leading to reoperation decreased. These improvements reflect the changes in practice (supplemental rod, proximal junctional kyphosis prophylaxis, bone morphogenetic protein use, anterior correction) to ensure maintenance of status or improved outcomes.
摘要：
目的：成人脊柱畸形是一种复杂的病理，从手术治疗中受益匪浅。尽管不断创新,关于手术技术的持续变化和并发症发生率知之甚少。当前研究的目的是调查单个前瞻性多中心数据库中患者概况和手术并发症的演变。
方法：本研究是对前瞻性，成人脊柱畸形（胸椎后凸>60°，矢状垂直轴>5厘米，骨盆倾斜>25°,或Cobb角>20°），至少随访2年。按手术日期将患者分为3组。三组人口统计数据，术前数据,手术信息,然后比较并发症。320名患者的移动平均值用于可视化和调查整个登记期间并发症的演变。
结果：共有928/1260例（73.7%）患者完成了2年的随访，每月入选率为7.7±4.1例。在整个招募期间（2008-2018年），患者变老（平均年龄从56.7岁增加到64.3岁）和病情加重（Charlson合并症指数中位数从1.46上升到2.08），较纯矢状畸形（N型）。手术治疗的变化包括增加椎间融合的使用，更多的前柱释放，三柱截骨率下降，较短的融合，和更多的补充棒和骨形态发生蛋白的使用。与再次手术相关的主要并发症（从27.4％到17.1％）显着减少，原因是放射线照相失败减少（从12.3％到5.2％）。尽管神经系统并发症略有增加。总体并发症发生率随着时间的推移而下降，2014年8月至2017年3月期间并发症发生率最低(51.8%).与再次手术相关的主要并发症在2014-2015年迅速减少。在2014年2月至2016年10月期间，与再次手术无关的主要并发症水平最低（21.0%）。
结论：尽管病例的复杂性增加，并发症发生率没有增加，导致再次手术的并发症发生率下降。这些改进反映了实践中的变化(补充杆，近端交界后凸畸形预防，骨形态发生蛋白的使用，前路矫正)，以确保维持状态或改善结局。
方法：本研究是对前瞻性，成人脊柱畸形（胸椎后凸>60°，矢状垂直轴>5厘米，骨盆倾斜>25°,或Cobb角>20°），至少随访2年。按手术日期将患者分为3组。三组人口统计数据，术前数据,手术信息,然后比较并发症。320名患者的移动平均值用于可视化和调查整个登记期间并发症的演变。
结果：共有928/1260例（73.7%）患者完成了2年的随访，每月入选率为7.7±4.1例。在整个招募期间（2008-2018年），患者变老（平均年龄从56.7岁增加到64.3岁）和病情加重（Charlson合并症指数中位数从1.46上升到2.08），较纯矢状畸形（N型）。手术治疗的变化包括增加椎间融合的使用，更多的前柱释放，三柱截骨率下降，较短的融合，和更多的补充棒和骨形态发生蛋白的使用。与再次手术相关的主要并发症（从27.4％到17.1％）显着减少，原因是放射线照相失败减少（从12.3％到5.2％）。尽管神经系统并发症略有增加。总体并发症发生率随着时间的推移而下降，2014年8月至2017年3月期间并发症发生率最低(51.8%).与再次手术相关的主要并发症在2014-2015年迅速减少。在2014年2月至2016年10月期间，与再次手术无关的主要并发症水平最低（21.0%）。
结论：尽管病例的复杂性增加，并发症发生率没有增加，导致再次手术的并发症发生率下降。这些改进反映了实践中的变化(补充杆，近端交界后凸畸形预防，骨形态发生蛋白的使用，前路矫正)，以确保维持状态或改善结局。
