Watkins Robert G, Hanna Robert, Chang David, Watkins Robert G
Marina Spine Center, Marina del Rey, CA.
J Spinal Disord Tech. 2014 Jul;27(5):253-6. doi: 10.1097/BSD.0b013e31828a8447.
Retrospective radiographic analysis.
To determine which lumbar interbody technique is most effective for restoring lordosis, increasing disk height, and reducing spondylolisthesis.
Lumbar interbody fusions are performed in hopes of increasing fusion potential, correcting deformity, and indirectly decompressing nerve roots. No published study has directly compared anterior, lateral, and transforaminal lumber interbody fusions in terms of ability to restore lordosis, increase disk height, and reduce spondylolisthesis.
Lumbar interbody fusion techniques were retrospectively compared in terms of improvement of lordosis, disk height, and spondylolisthesis between preoperative and follow-up lateral radiographs.
A total of 220 consecutive patients with 309 operative levels were compared by surgery type: anterior (184 levels), lateral (86 levels), and transforaminal (39 levels). Average follow-up was 19.2 months (range, 1-56 mo), with no statistical difference between the groups. Intragroup analysis showed that the anterior (4.5 degrees) and lateral (2.2 degrees) groups significantly improved lordosis from preoperative to follow-up, whereas the transforaminal (0.8 degrees) group did not. Intergroup analysis showed that the anterior group significantly improved lordosis more than both the lateral and transforaminal groups. The anterior (2.2 mm) and lateral (2.0 mm) groups both significantly improved disk height more than the transforaminal (0.5 mm) group. All 3 groups significantly reduced spondylolisthesis, with no difference between the groups.
After lumbar interbody fusion, improvement of lordosis was significant for both the anterior and lateral groups, but not the transforaminal group. Intergroup analysis showed the anterior group had significantly improved lordosis compared to both the other groups. The anterior and lateral groups had significantly increased disk height compared to the transforaminal group. All the 3 groups significantly reduced spondylolisthesis, with no difference between the groups.
回顾性影像学分析。
确定哪种腰椎椎间技术在恢复腰椎前凸、增加椎间盘高度和减少椎体滑脱方面最有效。
进行腰椎椎间融合术旨在提高融合潜力、矫正畸形并间接减压神经根。尚无已发表的研究在恢复腰椎前凸、增加椎间盘高度和减少椎体滑脱能力方面对前路、侧方和经椎间孔腰椎椎间融合术进行直接比较。
通过术前和术后随访的侧位X线片，对腰椎椎间融合技术在腰椎前凸、椎间盘高度和椎体滑脱改善情况方面进行回顾性比较。
按手术类型对总共220例连续患者的309个手术节段进行了比较：前路（184个节段）、侧方（86个节段）和经椎间孔（39个节段）。平均随访时间为19.2个月（范围1 - 56个月），组间无统计学差异。组内分析显示，前路组（4.5度）和侧方组（2.2度）从术前到随访时腰椎前凸显著改善，而经椎间孔组（0.8度）未改善。组间分析显示，前路组腰椎前凸改善程度显著大于侧方组和经椎间孔组。前路组（2.2毫米）和侧方组（2.0毫米）椎间盘高度改善均显著大于经椎间孔组（0.5毫米）。所有三组椎体滑脱均显著减少，组间无差异。
腰椎椎间融合术后，前路组和侧方组腰椎前凸改善显著，经椎间孔组未改善。组间分析显示，前路组腰椎前凸改善程度显著大于其他两组。与经椎间孔组相比，前路组和侧方组椎间盘高度显著增加。所有三组椎体滑脱均显著减少，组间无差异。
