后路腰椎椎间融合术联合椎弓根螺钉固定后金属椎间融合器下沉

Subsidence of metal interbody cage after posterior lumbar interbody fusion with pedicle screw fixation.

作者信息

Tokuhashi Yasuaki, Ajiro Yasumitsu, Umezawa Natsuki

机构信息

Department of Orthopedic Surgery, Nihon University School of Medicine, 30-1 Oyaguchi-kamimachi, Itabashi-ku, Tokyo, 173-8610 Japan.

出版信息

Orthopedics. 2009 Apr;32(4).

DOI:
Abstract

Posterior lumbar interbody fusion is considered to be an excellent fusion procedure to stabilize anterior support, correct alignment in the sagittal and coronal plane, and achieve foraminal decompression by lifting the disk height. The metal interbody cage in posterior lumbar interbody fusion is thought to be useful to prevent collapse of the graft bone and to correct and maintain disk height; however, some studies have noted a gradual decrease of disk height due to cage subsidence. Therefore, to investigate the significance of cage subsidence, 86 disk levels radiographically confirmed to have good union in 66 patients with posterior lumbar interbody fusion combined with pedicle screw fixation and a single metal cage for degenerative lumbar disease were retrospectively evaluated. The follow-up period ranged from 3 years to 10 years 3 months, with a mean of 7 years 9 months. Cage subsidence often showed a gradual increase over time. At final follow-up, subsidence averaged 4.0 mm on the cranial surface and 2.7 mm on the caudal surface. Although the average increase of disk height was 3.2 mm immediately postoperatively, the final disk height decreased by 4.2 mm on average from that time. The degree of cage subsidence and decrease of disk height were not correlated with the final clinical results. Subsidence was not correlated with bone mineral density in the vertebral body, body weight, or site of the insertion. On the other hand, the wedge shape of the cage and the thickness of the resected endplate had a significant influence on cage subsidence.

摘要

腰椎后路椎间融合术被认为是一种出色的融合手术,可稳定前柱支撑、矫正矢状面和冠状面的对线,并通过增加椎间盘高度实现椎间孔减压。腰椎后路椎间融合术中的金属椎间融合器被认为有助于防止移植骨塌陷,并矫正和维持椎间盘高度;然而,一些研究指出,由于融合器下沉,椎间盘高度会逐渐降低。因此,为了研究融合器下沉的意义,我们对86个椎间盘节段进行了回顾性评估,这些节段经影像学证实,66例接受腰椎后路椎间融合术联合椎弓根螺钉固定及单个金属融合器治疗的退行性腰椎疾病患者达到了良好的融合。随访时间为3年至10年3个月,平均为7年9个月。融合器下沉通常随时间逐渐增加。在末次随访时,头侧表面下沉平均为4.0毫米,尾侧表面为2.7毫米。虽然术后即刻椎间盘高度平均增加了3.2毫米,但最终椎间盘高度较彼时平均下降了4.2毫米。融合器下沉程度和椎间盘高度降低与最终临床结果无关。下沉与椎体骨密度、体重或植入部位无关。另一方面,融合器的楔形形状和切除终板的厚度对融合器下沉有显著影响。

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