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Revision surgery in cervical spine.
European Spine Journal ( IF 2.6 ) Pub Date : 2020-01-04 , DOI: 10.1007/s00586-019-06281-x
Luca Papavero 1 , Paolo Lepori 2 , Gregor Schmeiser 1
Affiliation  

PURPOSE To report the indications, presurgical planning, operative techniques, complications for making decisions in cervical revision surgery (CRS). METHODS Hundred and two patients underwent CRS over a four-year period. Epidemiological data, the type of first surgery, CRS surgical techniques and complications were retrospectively evaluated. Pain and neurological symptoms were assessed according to the validated Odom criteria. CRS indications were classified into five categories: adjacent segment disease (ASD), infection (INF), implant failure-pseudarthrosis (IFP), non-infectious complication, and deformity. Patients were classified into three groups, according to the approach of the index procedure: anterior, posterior, or 360°. RESULTS The mean patient age was 63 years (59% males). ASD (40%), INF (23%), and IFP (22%) were observed in 85% of patients. CRS was performed with the same approach that was used in the index procedure in 64% of the anterior group and in 83% of the posterior group. In the 360° group, 64% of CRSs was performed with a posterior access. The early complication rate was 4.9%. The outcome was excellent in 19 patients (19%), good in 37 patients (36%), satisfactory in 27 patients (26%), and poor in six patients (6%). Thirteen patients (13%) were lost to follow-up. No implants failed radiologically or required surgical revision. CONCLUSIONS CRS required painstaking planning and mastery of a variety of surgical techniques. The results were rewarding in half and satisfactory in a quarter of the patients. The complication rate was lower than expected. In the most complex cases, referral to a specialized center is recommended. These slides can be retrieved under Electronic Supplementary Material.

中文翻译:

颈椎翻修手术。

目的报告颈椎翻修手术(CRS)的适应症,术前计划,手术技术,决策并发症。方法在四年期间,一百零二名患者接受了CRS。回顾性评估流行病学数据,首次手术的类型,CRS手术技术和并发症。根据验证的Odom标准评估疼痛和神经系统症状。CRS适应症分为五类:相邻节段疾病(ASD),感染(INF),植入失败-假关节(IFP),非感染性并发症和畸形。根据索引程序的方法,将患者分为三组:前,后或360°。结果平均患者年龄为63岁(男性占59%)。ASD(40%),INF(23%),在85%的患者中观察到IFP和IFP(22%)。64%的前组和83%的后组采用与索引程序相同的方法进行CRS。在360°组中,有64%的CRS通过后入路进行。早期并发症发生率为4.9%。19例(19%),37例(36%),27例(26%),6例(6%)差,结果良好。13名患者(13%)失访。没有植入物在放射学上失败或需要手术修复。结论CRS需要艰苦的计划和掌握各种外科技术。结果令人满意,一半的患者满意,一半的患者满意。并发症发生率低于预期。在最复杂的情​​况下,建议转至专门中心。
更新日期:2020-01-04
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