てんかん患者における肩安定化手術の再発率と転帰

Patients with seizure disorders face a heightened risk of shoulder instability, often presenting with complex pathology and greater bone loss than nonseizure patients. We hypothesize that seizure patients experience a higher rate of recurrent instability after primary shoulder stabilization as compared to nonseizure patients.

This single-institution retrospective study (2009-2023) compares patients with recurrent shoulder instability with and without a seizure history undergoing shoulder stabilization surgery. Procedures included Bankart repair, remplissage, Hill-Sachs bone grafting, Latarjet procedure, and distal tibia allograft.

Among 573 patients, 83 had seizures (46 epileptic, 37 nonepileptic). The seizure group was significantly older (29.1 vs. 24.9 years; P < .001), had higher body mass index (28.5 vs. 26.8; P = .010), greater comorbidities (Charlson-Deyo Comorbidity Index, American Society of Anesthesiologists scores, smoking, and depression; P < .001), and more glenoid bone loss (19% vs. 13%; P = .002). The direction of instability in the seizure group was anterior in 78% of patients (vs. 72%). Seizure patients had a significantly lower range of motion preoperatively and postoperatively. Seizure patients had worse postoperative visual analog scale (3.3 vs. 1.6; P = .001), Single Assessment Numeric Evaluation (75 vs. 86; P = .002), American Shoulder and Elbow Surgeons (69 vs. 87; P < .001), and Shoulder Instability-Return to Sport after Injury (42 vs. 71; P = .007) scores. Recurrent instability was significantly higher in seizure patients (28% vs. 17%; P = .022). In seizure patients, arthroscopic soft tissue repair had a high recurrence rate (48%), significantly worse than open bone augmentation (13%; P = .004). Nonseizure patients had similar recurrence rates for soft tissue repair (19%) and bone augmentation (15%; P = .33). Recurrence rates were comparable between seizure and nonseizure groups after bone augmentation (P = .833) but significantly higher in seizure patients undergoing soft tissue repair (P < .001). Instability-free survival at 2, 5, and 10 years was lower in seizure patients (P = .039) and lower for soft tissue repair vs. bone augmentation within the seizure group (P = .0016).

Seizure patients with shoulder instability have more comorbidities, worse clinical outcomes, and greater bone loss than nonseizure patients. Soft tissue repair in seizure patients has a high recurrence rate (48%), while bone augmentation procedures show lower recurrence, even after postoperative seizures. Bone augmentation should be strongly considered for these patients.