Access strategies for revision in anterior lumbar surgery
Access strategies for revision in anterior lumbar surgery
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DOI：
10.1097/brs.0b013e31817bb970
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发表时间：
2008-07-01
期刊：
影响因子：
3
通讯作者：
Bae, Hyun W.
中科院分区：
文献类型：
--
作者：
Brau, Salvador A.;Delamarter, Rick B.;Bae, Hyun W.
研究设计。对2000年2月至2007年9月期间连续接受前路腰椎翻修手术的62例患者进行入路策略和并发症的评估。 目的。确定这些患者并发症的发生率，并根据获得的结果提出未来修订的建议。背景数据摘要。文献中只有 2 篇文章讨论了这种情况，并且它们在少数患者中的结果差异很大。这个更大的系列可能有助于为接受前路腰椎翻修手术的患者的并发症的预期提供更多的确定性。方法。对这 62 名连续患者维护了一个并发数据库。对术前策略进行了评估，并在并发症发生时将其制成表格，随后进行分析，以便为未来类似病例提供建议。结果。 23 名患者进行了相同水平的修正，39 名患者进行了相邻水平的手术。静脉损伤 3 例（4.8%），动脉损伤 3 例（4.8%），输尿管损伤 1 例（1.6%）。所有 3 条动脉损伤均发生在 L4 至 S1 融合或椎间盘置换术后接近 L3-L4 时。所有 3 次静脉损伤和输尿管损伤均发生在接近先前手术水平时。其中六名患者的伤势得到修复，手术完成并完全康复。 L5-S1 的一次修订导致手术因静脉损伤而中止。没有死亡。结论。尽管翻修中并发症的发生率比指示病例高得多，但静脉、动脉和输尿管并发症的实际百分比对于必须进行此类手术的患者来说当然是可以接受的。只有非常有经验的通路外科医生才应该尝试修复手术。
Study Design. Sixty-two consecutive patients undergoing anterior lumbar revision surgery from February 2000 to September 2007 were evaluated for approach strategies and complications.Objective. To determine the incidence of complications in these patients and to make recommendations on future revisions based on the results obtained.Summary of Background Data. Only 2 articles exist in the literature that address this situation and they have widely varying results in a small number of patients. This larger series may help give more certainty to the expectations for complications in patients undergoing revision anterior lumbar surgery.Methods. A concurrent database was maintained on these 62 consecutive patients. Preoperative strategies were evaluated and complications were tabulated as they occurred and later analyzed to arrive at recommendations for future similar cases.Results. Twenty-three patients had the same level revised and 39 patients had adjacent levels operated on. There were 3 venous injuries (4.8%), 3 arterial injuries ( 4.8%), and 1 ureteral injury (1.6%). All 3 arterial injuries occurred while approaching L3-L4 after L4 to S1 prior fusion or disc replacement. All 3 venous injuries and the ureteral injury occurred while approaching a previously operated level or levels. Six of these patients had the injuries repaired and the procedures completed with full recovery. One L5-S1 revision had the procedure aborted after a venous injury. There were no deaths.Conclusion. Although the incidence of complications in revisions is much greater than for index cases, the actual percentage of venous, arterial, and ureteral complications is certainly acceptable for patients who must have this type of surgery. Only very experienced access surgeons should attempt revision surgery.