Fogel Guy R, Toohey John S, Neidre Arvo, Brantigan John W
South Texas Orthopaedic and Spinal Surgery Associates, 9150 Huebner Road, San Antonio, 78240, USA.
Spine J. 2006 Jul-Aug;6(4):421-7. doi: 10.1016/j.spinee.2005.09.011.
Posterior lumbar interbody fusion (PLIF) was introduced 50 years ago. The Lumbar I/F cage (DePuy Spine, Raynham, MA) was designed to enhance PLIF results. PLIF with the Lumbar I/F cage and posterior Variable Screw Placement System (VSP) has increased the success of fusion to nearly 100% at the four lowest lumbar levels, L2-L3 through L5-S1. Less commonly, PLIF is indicated for the L1-L2 level. Clinical-results of Lumbar I/F cage fusion and VSP at L1-L2 have-not been reported.
The purpose of this study is to report the functional outcomes, fusion rate, and complications related to PLIF with Lumbar I/F cage and VSP of L1-L2
STUDY DESIGN/SETTING: The setting is a retrospective, single-arm cohort study of consecutive PLIF surgical patients at a single center.
A review of 373 of 425 patients who underwent PLIF with Lumbar I/F cage and VSP from 1999 to 2002 identified 12 patients who had PLIF with Lumbar I/F cage and VSP at L1-L2. Mean follow-up was 31 months (range 12-65 months).
Clinical success was determined with a modified Prolo score evaluating pain, function, medication usage and economic status. Fusion success, determined by evaluation of plain radiographs, was defined by continuous bone bridging the fusion area with no lucencies.
The 12 patients were evaluated for clinical success and/fusion success at last follow-up. These results were compared with the results of the 373 patients reviewed, and historical groups of the original Investigational Device Exemption study and the 10-year follow-up study.
Previous surgery was reported by 10 of 12 patients, with an average symptom-free period of 3 years after previous fusion and before presentation with severe symptomatology necessitating further surgery at L1-L2. Seven patients had clinical success (59%), and five patients were clinically unsuccessful (41%). This included zero excellent, 2 of 12 (15%) good, 5 of 12 (42%) fair, and 5 of 12 (42%) poor results. Fusion was successful in seven (58%) and failed in five patients (42%). Three failed fusions were associated with L1-L2 subsidence. Two patients required further revision for non-union.
In 12 patients with L1-L2 fusion, we report an unexpected high rate of failed fusion and poor clinical outcome.
后路腰椎椎间融合术（PLIF）于50年前被引入。腰椎I/F椎间融合器（DePuy脊柱公司，马萨诸塞州雷纳姆）旨在提高PLIF的效果。采用腰椎I/F椎间融合器和后路可变螺钉置入系统（VSP）进行PLIF，在最低的四个腰椎节段（L2-L3至L5-S1）融合成功率已提高至近100%。L1-L2节段行PLIF的情况较少见。目前尚无关于L1-L2节段采用腰椎I/F椎间融合器融合及VSP的临床结果报道。
本研究旨在报告L1-L2节段采用腰椎I/F椎间融合器和VSP进行PLIF的功能结果、融合率及并发症。
研究设计/地点：本研究为对单一中心连续行PLIF手术患者的回顾性单臂队列研究。
回顾1999年至2002年期间425例行腰椎I/F椎间融合器和VSP的PLIF患者中的373例，确定12例在L1-L2节段行腰椎I/F椎间融合器和VSP的PLIF患者。平均随访时间为31个月（范围12-至65个月）。
采用改良的普罗洛评分评估疼痛、功能、药物使用及经济状况来确定临床成功与否。通过X线平片评估确定融合成功，定义为融合区域有连续骨桥形成且无透亮区。
对12例患者在末次随访时进行临床成功和/或融合成功评估。将这些结果与373例回顾患者的结果以及原始研究器械豁免研究和10年随访研究的历史组结果进行比较。
12例患者中有10例曾接受过手术，上次融合后至因L1-L2节段出现严重症状而需要进一步手术前，平均无症状期为3年。7例患者临床成功（59%），5例患者临床失败（41%）。其中无优，12例中有2例（15%）良，12例中有5例（42%）可，12例中有5例（42%）差。7例（58%）融合成功，5例（42%）失败。3例融合失败与L1-L2节段沉降有关。2例患者因不愈合需要进一步翻修。
在12例L1-L2节段融合患者中，我们报告融合失败率和临床效果差的发生率意外地高。
