Security and Efficacy of Single-Stage versus 2-Stage Spinal Fusion by way of Posterior Instrumentation and Anterior Thoracoscopy: A Retrospective Matched-Pair Cohort Examine with 247 Consecutive Sufferers.
World Neurosurg. 2018 Jan;109:e739-e747
Authors: Viezens L, Reer P, Strahl A, Weiser L, Schroeder M, Beyerlein J, Schaefer C
OBJECTIVE: Posterior-anterior spondylodesis is usually used to stabilize the backbone in numerous pathologies. The anterior process is usually carried out by way of thoracoscopy. It’s unclear whether or not the anterior process ought to be carried out instantly after posterior instrumentation or after the affected person has convalesced. This retrospective examine in contrast perioperative security and morbidity in 1-stage versus 2-stage posterior-anterior fusion surgical procedure with a thoracoscopic anterior strategy.
METHODS: All consecutive sufferers who underwent surgical procedure for posterior-anterior spinal stabilization from 2006 to 2013 have been included. American Society of Anesthesiologists rating, preoperative and postoperative laboratory values, operation period, blood loss, intensive care unit keep, ache, postoperative hospital keep, perioperative problems, and preoperative and postoperative Japanese Cooperative Oncology Group and Frankel scores have been assessed. A subset of the cohort was chosen by propensity rating matching to eradicate doable choice bias.
RESULTS: There have been 247 sufferers who underwent 1-stage (n = 104) or 2-stage (n = 143) stabilization with thoracoscopic fusion. Spinal pathologies have been fracture, malignancy, pyogenic spondylodiscitis, degenerative spinal issues, and failed earlier surgical procedure. One-stage and 2-stage procedures have been related when it comes to preoperative, surgical, and postoperative variables, together with complication charges, besides that the 1-stage process was related to larger ache 2 days after surgical procedure and shorter hospital keep. The propensity score-matched cohort of 64 pairs yielded related outcomes with solely 1-stage sufferers displaying elevated visible analog scale rating on postoperative day 2 (three.eight vs. 2.four, P = zero.043).
CONCLUSIONS: One-stage stabilization was as protected as 2-stage stabilization and related to shorter hospitalization. Higher ache after the 1-stage process, which resolved 30 days after surgical procedure, displays the truth that 2-stage sufferers already had ache reduction after they underwent thoracoscopy.
PMID: 29079258 [PubMed – indexed for MEDLINE]