European Spine Journal最新文献

Purpose: Mental health disorders have been shown to influence surgical outcomes, yet their effects on cervical spine surgery remain incompletely defined. This study evaluated the impact of depression and psychotic disorders on (1) perioperative complications, (2) discharge disposition, and (3) hospital resource utilization following anterior cervical discectomy and fusion (ACDF).

Methods: The National Inpatient Sample (NIS) was queried for adult ACDF admissions from 2016 to 2022. Patients were classified into those with either no mental illness, depression, or psychotic disorder. Medical/surgical complications, dysphagia, and overall adverse events were extracted using ICD-10 diagnosis codes. Discharge status, inpatient mortality, costs, and length of stay were also evaluated across all cohorts. Subsequent analyses were adjusted for demographics, Elixhauser comorbidity index, hospital characteristics, and levels fused. Fusion level was included as a categorical covariate (single-level vs. multilevel) in all adjusted regression models. Multivariable logistic regression estimated adjusted odds ratios for complications/discharge outcomes, while weighted linear models compared/contrasted healthcare utilization with statistical significance set at P < 0.05.

Results: 376,130 inpatient ACDFs were identified (64,020 with depression, 11,255 with psychotic disorders). Depression was associated with increased cardiovascular complications (OR 1.28, 95% CI 1.16-1.41), dysphagia (OR 1.09, 95% CI 1.02-1.18), and non-routine discharge (OR 1.15, 95% CI 1.09-1.21). Psychotic disorders were associated with increased rates of cardiovascular events (OR 1.29, 95% CI 1.04-1.59), mechanical complications (OR 1.36, 95% CI 1.01-1.83), and non-routine discharge (OR 1.47, 95% CI 1.32-1.64). Both mean costs and length of stay were likewise higher in patients with mental disorders (P < 0.001).

Conclusion: Mental health disorders are associated with increased postoperative complications, non-routine discharge, and healthcare utilization following ACDF. Appropriate diagnosis, management, and preoperative optimization may improve outcomes in this patient population.

Study design: Technical case report.

Introduction: Severe thoracic hyperkyphosis caused by multiple osteoporotic fractures can lead to significant disability. When deformities are rigid, surgical correction may be required. This report describes a rare case of four-level pedicle subtraction osteotomy (PSO) to address a fixed deformity, with focus on technique, outcomes, and complications.

Case presentation: A 65-year-old female with Scheuermann's disease developed progressive thoracic hyperkyphosis due to osteoporotic vertebral fractures. Radiographs showed a rigid kyphosis of 130.3°. The patient underwent a two-stage surgery: cement-augmented instrumentation (T2-L3), followed by contiguous PSOs from T6 to T9. Neurophysiological monitoring was used throughout.

Results: Kyphosis was corrected from 130.3° to 48°. Postoperatively, the patient developed progressive lower limb weakness due to spinal cord kinking. Revision surgery allowed neurological recovery. At two years, radiological parameters remained stable, and the patient reported reduced pain, improved mobility, and restored quality of life.

Conclusion: Four-level PSO can be an effective treatment for severe rigid thoracic hyperkyphosis in osteoporotic patients. Although technically demanding and associated with potential complications, careful planning and staged correction can result in successful outcomes.

Level of evidence: IV (Case Report).