Abstract：
METHODS: This study was a retrospective multi-center comparative cohort study.
METHODS: A retrospective institutional database of operative adult spinal deformity patients was utilized. All fusions > 5 vertebral levels and including the sacrum/pelvis were eligible for inclusion. Revisions, 3 column osteotomies, and patients with < 2-year clinical follow-up were excluded. Patients were separated into 3 groups based on surgical approach: 1) posterior spinal fusion without interbody (PSF), 2) PSF with interbody (PSF-IB), and 3) anteroposterior (AP) fusion (anterior lumbar interbody fusion or lateral lumbar interbody fusion with posterior screw fixation). Intraoperative, radiographic, and clinical outcomes, as well as complications, were compared between groups with ANOVA and χ2 tests.
RESULTS: One-hundred and thirty-eight patients were included for study (PSF, n = 37; PSF-IB, n = 44; AP, n = 57). Intraoperatively, estimated blood loss was similar between groups (p = 0.171). However, the AP group had longer operative times (547.5 min) compared to PSF (385.1) and PSF-IB (370.7) (p < 0.001). Additionally, fusion length was shorter in PSF-IB (11.4) compared to AP (13.6) and PSF (12.9) (p = 0.004). There were no differences between the groups in terms of change in alignment from preoperative to 2 years postoperative. There were no differences in clinical outcomes. While postoperative complications were largely similar between groups, operative complications were higher in the AP group (31.6%) compared to the PSF (5.4%) and PSF-IB (9.1) groups (p < 0.001).
CONCLUSIONS: While there were differences in intraoperative outcomes (operative time and fusion length), there were no differences in postoperative clinical or radiographic outcomes. AP fusion was associated with a higher rate of operative complications.
METHODS: A retrospective institutional database of operative adult spinal deformity patients was utilized. All fusions > 5 vertebral levels and including the sacrum/pelvis were eligible for inclusion. Revisions, 3 column osteotomies, and patients with < 2-year clinical follow-up were excluded. Patients were separated into 3 groups based on surgical approach: 1) posterior spinal fusion without interbody (PSF), 2) PSF with interbody (PSF-IB), and 3) anteroposterior (AP) fusion (anterior lumbar interbody fusion or lateral lumbar interbody fusion with posterior screw fixation). Intraoperative, radiographic, and clinical outcomes, as well as complications, were compared between groups with ANOVA and χ2 tests.
RESULTS: One-hundred and thirty-eight patients were included for study (PSF, n = 37; PSF-IB, n = 44; AP, n = 57). Intraoperatively, estimated blood loss was similar between groups (p = 0.171). However, the AP group had longer operative times (547.5 min) compared to PSF (385.1) and PSF-IB (370.7) (p < 0.001). Additionally, fusion length was shorter in PSF-IB (11.4) compared to AP (13.6) and PSF (12.9) (p = 0.004). There were no differences between the groups in terms of change in alignment from preoperative to 2 years postoperative. There were no differences in clinical outcomes. While postoperative complications were largely similar between groups, operative complications were higher in the AP group (31.6%) compared to the PSF (5.4%) and PSF-IB (9.1) groups (p < 0.001).
CONCLUSIONS: While there were differences in intraoperative outcomes (operative time and fusion length), there were no differences in postoperative clinical or radiographic outcomes. AP fusion was associated with a higher rate of operative complications.
摘要：
方法：本研究为回顾性多中心比较队列研究。
方法：采用回顾性的成人脊柱畸形手术患者的机构数据库。包括骶骨/骨盆在内的所有>5个椎体水平的融合均符合纳入条件。修订,3柱截骨术，临床随访<2年的患者被排除在外。根据手术入路将患者分为3组:1)后路无椎间融合术(PSF),2)带椎体间的PSF(PSF-IB)，和3）前后路（AP）融合（前路腰椎椎体间融合或后路螺钉固定的外侧腰椎椎体间融合）。术中,射线照相,和临床结果，以及并发症，组间比较采用方差分析和χ2检验。
结果：纳入了118名患者进行研究（PSF，n=37；PSF-IB，n=44；AP，n=57）。术中,两组间估计的失血量相似(p=0.171).然而,与PSF(385.1)和PSF-IB(370.7)相比,AP组手术时间更长(547.5min)(p<0.001).此外,与AP(13.6)和PSF(12.9)相比,PSF-IB(11.4)的融合长度较短(p=0.004).从术前到术后2年，两组之间的对齐变化没有差异。临床结果无差异。虽然术后并发症在各组之间基本相似，与PSF(5.4%)和PSF-IB(9.1)组相比,AP组(31.6%)的手术并发症较高(p<0.001).
结论：虽然术中结果（手术时间和融合长度）存在差异，术后临床或影像学结局无差异.AP融合与较高的手术并发症发生率相关。
方法：采用回顾性的成人脊柱畸形手术患者的机构数据库。包括骶骨/骨盆在内的所有>5个椎体水平的融合均符合纳入条件。修订,3柱截骨术，临床随访<2年的患者被排除在外。根据手术入路将患者分为3组:1)后路无椎间融合术(PSF),2)带椎体间的PSF(PSF-IB)，和3）前后路（AP）融合（前路腰椎椎体间融合或后路螺钉固定的外侧腰椎椎体间融合）。术中,射线照相,和临床结果，以及并发症，组间比较采用方差分析和χ2检验。
结果：纳入了118名患者进行研究（PSF，n=37；PSF-IB，n=44；AP，n=57）。术中,两组间估计的失血量相似(p=0.171).然而,与PSF(385.1)和PSF-IB(370.7)相比,AP组手术时间更长(547.5min)(p<0.001).此外,与AP(13.6)和PSF(12.9)相比,PSF-IB(11.4)的融合长度较短(p=0.004).从术前到术后2年，两组之间的对齐变化没有差异。临床结果无差异。虽然术后并发症在各组之间基本相似，与PSF(5.4%)和PSF-IB(9.1)组相比,AP组(31.6%)的手术并发症较高(p<0.001).
结论：虽然术中结果（手术时间和融合长度）存在差异，术后临床或影像学结局无差异.AP融合与较高的手术并发症发生率相关。
