Lennart Viezens1, Phillip Reer2, Andre Strahl2, Lukas Weiser3, Malte Schroeder4, Joerg Beyerlein5, Christian Schaefer4. 1. Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Trauma, Hand, and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Trauma, Orthopaedic, and Plastic Surgery, University Medical Center Goettingen, Goettingen, Germany. Electronic address: Lennart.viezens@med.uni-goettingen.de. 2. Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 3. Department of Trauma, Orthopaedic, and Plastic Surgery, University Medical Center Goettingen, Goettingen, Germany. 4. Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Spine Surgery, Klinikum Bad Bramstedt, Bad Bramstedt, Germany. 5. Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Spine Surgery, Albertinen Hospital Hamburg, Hamburg, Germany.
Abstract
OBJECTIVE: Posterior-anterior spondylodesis is often used to stabilize the spine in various pathologies. The anterior procedure is often performed via thoracoscopy. It is unclear whether the anterior procedure should be performed immediately after posterior instrumentation or after the patient has convalesced. This retrospective study compared perioperative safety and morbidity in 1-stage versus 2-stage posterior-anterior fusion surgery with a thoracoscopic anterior approach. METHODS: All consecutive patients who underwent surgery for posterior-anterior spinal stabilization from 2006 to 2013 were included. American Society of Anesthesiologists score, preoperative and postoperative laboratory values, operation duration, blood loss, intensive care unit stay, pain, postoperative hospital stay, perioperative complications, and preoperative and postoperative Eastern Cooperative Oncology Group and Frankel scores were assessed. A subset of the cohort was selected by propensity score matching to eliminate possible selection bias. RESULTS: There were 247 patients who underwent 1-stage (n = 104) or 2-stage (n = 143) stabilization with thoracoscopic fusion. Spinal pathologies were fracture, malignancy, pyogenic spondylodiscitis, degenerative spinal disorders, and failed previous surgery. One-stage and 2-stage procedures were similar in terms of preoperative, surgical, and postoperative variables, including complication rates, except that the 1-stage procedure was associated with greater pain 2 days after surgery and shorter hospital stay. The propensity score-matched cohort of 64 pairs yielded similar results with only 1-stage patients showing elevated visual analog scale score on postoperative day 2 (3.8 vs. 2.4, P = 0.043). CONCLUSIONS: One-stage stabilization was as safe as 2-stage stabilization and associated with shorter hospitalization. Greater pain after the 1-stage procedure, which resolved 30 days after surgery, reflects the fact that 2-stage patients already had pain relief when they underwent thoracoscopy.
OBJECTIVE: Posterior-anterior spondylodesis is often used to stabilize the spine in various pathologies. The anterior procedure is often performed via thoracoscopy. It is unclear whether the anterior procedure should be performed immediately after posterior instrumentation or after the patient has convalesced. This retrospective study compared perioperative safety and morbidity in 1-stage versus 2-stage posterior-anterior fusion surgery with a thoracoscopic anterior approach. METHODS: All consecutive patients who underwent surgery for posterior-anterior spinal stabilization from 2006 to 2013 were included. American Society of Anesthesiologists score, preoperative and postoperative laboratory values, operation duration, blood loss, intensive care unit stay, pain, postoperative hospital stay, perioperative complications, and preoperative and postoperative Eastern Cooperative Oncology Group and Frankel scores were assessed. A subset of the cohort was selected by propensity score matching to eliminate possible selection bias. RESULTS: There were 247 patients who underwent 1-stage (n = 104) or 2-stage (n = 143) stabilization with thoracoscopic fusion. Spinal pathologies were fracture, malignancy, pyogenic spondylodiscitis, degenerative spinal disorders, and failed previous surgery. One-stage and 2-stage procedures were similar in terms of preoperative, surgical, and postoperative variables, including complication rates, except that the 1-stage procedure was associated with greater pain 2 days after surgery and shorter hospital stay. The propensity score-matched cohort of 64 pairs yielded similar results with only 1-stage patients showing elevated visual analog scale score on postoperative day 2 (3.8 vs. 2.4, P = 0.043). CONCLUSIONS: One-stage stabilization was as safe as 2-stage stabilization and associated with shorter hospitalization. Greater pain after the 1-stage procedure, which resolved 30 days after surgery, reflects the fact that 2-stage patients already had pain relief when they underwent thoracoscopy.