Clinical Spine Surgery ( IF 1.9 ) Pub Date : 2022-08-01 , DOI: 10.1097/bsd.0000000000001322 Kern Singh 1 , Elliot D K Cha 1 , Conor P Lynch 1 , Michael T Nolte 1 , James M Parrish 1 , Nathaniel W Jenkins 1 , Kevin C Jacob 1 , Madhav R Patel 1 , Nisheka N Vanjani 1 , Hanna Pawlowski 1 , Michael C Prabhu 1 , Jonathan A Myers 2
Study Design:
This was a retrospective cohort study.
Objective:
Develop an evidence-based preoperative risk assessment scoring system for patients undergoing anterior lumbar interbody fusion (ALIF).
Summary of Background Data:
ALIF may hold advantages over other fusion techniques in sagittal restoration and fusion rates, though it introduces unique risks to vascular and abdominal structures and thus possibly increased risk of operative morbidity.
Methods:
Primary, 1 or 2-level ALIFs were identified in a surgical registry. Baseline characteristics were recorded. Axial magnetic resonance imagings at L4–L5 and L5–S1 were reviewed for vascular confluence/bifurcation or anomalous structures, and measured for operative window size/slope. To assess favorable outcomes, a clinical grade was calculated: (clinical grade=blood loss×operative duration), higher value indicating poorer outcome. To establish a risk scoring system, a base risk score algorithm was established and stratified into 5 categories: high, high to intermediate, intermediate, intermediate to low, and low. Modifiers to base risk score included age, body mass index, operative level, history of bone morphogenic protein use, calcified vasculature, spondylolisthesis grade, working window size and slope, and abnormal vasculature. Modifiers were weighted for contribution to surgical risk. A total risk score was calculated and evaluated for strength of association with clinical outcome grades by Pearson correlation coefficient.
Results:
A total of 65 patients were included. Mean clinical outcome grade was 5.6, mean total risk score 21.3±21.5. Multilevel procedures (L4–S1) mean total risk score was 57.3±7.8. L4–L5 mean total risk score was 23.6±5.2; L5–S1 mean total risk score 8.3±6.6. Correlation analysis demonstrated a significant and strong relationship (|r|=0.753; P<0.001) between total risk scores and clinical outcome grades.
Conclusion:
Calculated ALIF risk scores significantly correlated with operative duration and blood loss. This scoring system represents a potential framework to facilitate clinical decision-making and risk assessment for potential ALIF candidates with degenerative spinal pathologies.
中文翻译:
退行性脊柱疾病中前路腰椎间融合通路的风险评估
学习规划:
这是一项回顾性队列研究。
客观的:
为接受前路腰椎椎间融合术(ALIF)的患者开发基于证据的术前风险评估评分系统。
背景数据摘要:
ALIF 在矢状面恢复和融合率方面可能比其他融合技术具有优势,尽管它会给血管和腹部结构带来独特的风险,从而可能增加手术发病的风险。
方法:
在外科登记中发现了原发性 1 级或 2 级 ALIF。记录基线特征。检查 L4-L5 和 L5-S1 处的轴向磁共振成像是否有血管汇合/分叉或异常结构,并测量手术窗口尺寸/坡度。为了评估良好的结果,计算临床等级:(临床等级=失血量×手术时间),值越高表明结果越差。为了建立风险评分系统,建立了基本风险评分算法,并将其分为 5 个类别:高、高到中、中、中到低和低。基本风险评分的修正因素包括年龄、体重指数、手术水平、骨形态发生蛋白使用史、钙化脉管系统、脊椎滑脱等级、工作窗大小和斜率以及异常脉管系统。对修饰因素对手术风险的贡献进行加权。计算总风险评分并通过皮尔逊相关系数评估与临床结果等级的关联强度。
结果:
总共包括 65 名患者。平均临床结果等级为5.6,平均总风险评分为21.3±21.5。多级程序(L4–S1)平均总风险评分为 57.3±7.8。L4-L5平均总风险评分为23.6±5.2;L5–S1 平均总风险评分 8.3±6.6。相关性分析表明总风险评分与临床结果等级之间存在显着且牢固的关系(| r |=0.753;P <0.001)。
结论:
计算得出的 ALIF 风险评分与手术持续时间和失血量显着相关。该评分系统代表了一个潜在的框架,可促进患有退行性脊柱病变的潜在 ALIF 候选者的临床决策和风险评估。