Impact of Age on Change in Self-Image 5 Years After Complex Spinal Fusion (≥5 Levels)
Impact of Age on Change in Self-Image 5 Years After Complex Spinal Fusion (≥5 Levels)
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DOI：
10.1016/j.wneu.2016.09.095
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发表时间：
2017-01-01
影响因子：
2
通讯作者：
Karikari, Isaac O.
中科院分区：
文献类型：
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作者：
Elsamadicy, Aladine A.;Adogwa, Owoicho;Karikari, Isaac O.
背景：需要>= 5融合水平的脊柱畸形对外科医生和患者来说都是困难和具有挑战性的。中度至重度畸形矫正已被证明可以改善患者报告的预后（PROs），并为患者提供更好的生活质量。自我形象是一个重要的PRO，因为它揭示了患者对健康的看法，以及作为接受矫正手术的脊柱畸形患者满意度的代理。然而，随着人口老龄化，年龄对自我形象长期变化的影响尚不清楚。本研究的目的是确定年龄对择期复杂脊柱融合术5年后自我形象的影响（>= 5级）。方法：回顾性分析2002年1月至2008年12月接受>= 5节段骶骨融合髂内固定的55例成人患者（>= 18岁）的前瞻性资料。患者按年龄分组：年轻（= 60岁）。收集患者统计资料、合并症、术前变量（矢状角和Cobb角）和术后并发症发生率。所有患者都有前瞻性收集的结果测量和至少5年的随访。术前和随访（术后至少5年）完成PRO仪器SRS-22r（功能、自我形象、心理健康和疼痛）。本研究调查的主要结果是术后自我形象的改变。结果：两个队列的基线特征和术前变量相似。术中变量无显著差异，包括队列间融合水平的平均+/-标准差数（年轻人11.2 +/- 4.3 vs老年人12.1 +/- 4.0;P = 0.42）。两组患者的并发症发生率相似，并发症类型无显著差异（年轻人29.63% vs老年人25.0%;P = 0.77）。两组患者术前和随访的PROs无显著差异。术前和随访自我形象评分的平均+/-标准差分别为（年轻人，2.35 +/- 0.58 vs.老年人，2.68 +/- 0.64;P = 0.51）和（年轻人，3.82 +/- 0.63 vs.老年人，3.51 +/- 0.94）。两组患者在功能改变、心理健康或疼痛方面没有显著差异。然而，年轻队列的自我形象总体变化明显大于年长队列（年轻，1.49 +/- 0.87 vs.年长，0.70 +/- 1.14;P = 0.01）。结论：我们的研究表明，年龄显著影响畸形矫形术后的自我形象感知；年轻患者术后自我形象的变化比基线更大。需要进一步的研究来证实我们观察到的发现。
BACKGROUND: Spinal deformities that require >= 5 fusion levels are difficult and challenging for both the surgeon and patient. Corrections of moderate to severe deformities have been shown to improve patient-reported outcomes (PROs), and provide patients with a better quality of life. Self-image is an important PRO because it sheds insight into the patient's perception of health, as well as serving as a proxy of satisfaction for patients with spine deformity undergoing corrective surgery. However, with an aging population, the impact of age on long-term change in self-image is unknown. The aim of this study is to determine the effects of age on self-image 5 years after undergoing an elective complex spinal fusion (>= 5 levels).METHODS: This was a retrospective analysis of prospectively collected data of 55 adult patients (>= 18 years old) undergoing >= 5 levels of spinal fusion to the sacrum with iliac fixation from January 2002 to December 2008. Patients were grouped by age: young (= 60 years old). Patient demographics, comorbidities, preoperative variables (sagittal and Cobb angles) and postoperative complication rates were collected. All patients had prospectively collected outcome measures and a minimum of 5 years follow-up. PRO instrument SRS-22r (function, self-image, mental health, and pain) was completed before surgery then at follow-up (at least 5 years after surgery). The primary outcome investigated in this study was the change in self-image after surgery.RESULTS: Baseline characteristics and preoperative variables were similar in both cohorts. There were no significant differences in intraoperative variables, including the mean +/- standard deviation number of fusion levels between the cohorts (young, 11.2 +/- 4.3 vs. older, 12.1 +/- 4.0; P = 0.42). Complication rates were similar between the cohorts, with no significant differences in the types of complications (young, 29.63% vs. older, 25.0%; P = 0.77). There were no significant differences in preoperative and follow-up PROs between the cohorts. The mean +/- standard deviation preoperative and follow-up self-image scores were (young, 2.35 +/- 0.58 vs. older, 2.68 +/- 0.64; P = 0.51) and (young, 3.82 +/- 0.63 vs. older, 3.51 +/- 0.94), respectively. There were no significant differences in the change of function, mental health, or pain between the cohorts. However, the younger cohort experienced a significantly greater overall change in self-image than did the older cohort (young, 1.49 +/- 0.87 vs. older, 0.70 +/- 1.14; P = 0.01).CONCLUSIONS: Our study suggests that age significantly affects the perception of self-image after deformity correction surgery; with younger patients reporting a greater change from baseline in self-image after surgery. Further studies are necessary to corroborate our observed findings.