Lee Gun Woo, Shin Ji-Hoon, Ryu Seung Min, Ahn Myun-Whan
Department of Orthopaedic Surgery, Spine Center, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, Republic of Korea.
Clin Spine Surg. 2018 Feb;31(1):E62-E68. doi: 10.1097/BSD.0000000000000536.
Retrospective review of prospectively collected data.
To determine the impact of L5 sacralization on fusion rates and clinical outcomes after single-level posterior lumbar interbody fusion (PLIF) surgery at the L4-L5 level.
L5 sacralization can produce greater stress concentration at the adjacent segment (L4-L5); therefore, L4-L5 PLIF surgery in patients with L5 sacralization may negatively affect fusion rate and be associated with poor clinical outcomes. However, no study has examined the impact of L5 sacralization on fusion rates and clinical outcomes of patients who undergo L4-L5 PLIF surgery.
Of 153 patients who underwent L4-L5 PLIF, data of 145 who met the study criteria were retrospectively reviewed. Among them, 31 patients had L5 sacralization (group A), whereas the remaining 114 patients did not (group B). The primary study endpoint was fusion rate evaluated using dynamic radiographs and computed tomographic scans. Secondary endpoints included (1) pain intensity in the lower back and radiating to the lower extremities on the visual analog scale; (2) clinical outcomes assessed using the Oswestry Disability Index and 12-item Short Form Health Survey; (3) surgical outcomes; and (4) complications.
Fusion rate evaluated using dynamic radiographs and computed tomographic scans at 6 months after surgery did not differ significantly between patients with and without sacralization (P=0.70 and 0.81, respectively), whereas fusion rate at 1 year after surgery did (P=0.04 and 0.04, respectively). In particular, patients with type II or III L5 sacralization had significantly lower fusion rates than those with other types of or no L5 sacralization. Pain intensity, clinical and surgical outcomes, and complications did not differ significantly between groups.
Patients with type II or III L5 sacralization may have worse fusion rates after L4-L5 PLIF surgery than those with type I or no sacralization.
对前瞻性收集的数据进行回顾性分析。
确定L5骶化对L4-L5节段单节段后路腰椎椎间融合术（PLIF）术后融合率及临床疗效的影响。
L5骶化可在相邻节段（L4-L5）产生更大的应力集中；因此，L5骶化患者行L4-L5 PLIF手术可能会对融合率产生负面影响，并与不良临床疗效相关。然而，尚无研究探讨L5骶化对接受L4-L5 PLIF手术患者融合率及临床疗效的影响。
在153例行L4-L5 PLIF手术的患者中，对符合研究标准的145例患者的数据进行回顾性分析。其中，31例患者存在L5骶化（A组），其余114例患者无L5骶化（B组）。主要研究终点为采用动态X线片和计算机断层扫描评估的融合率。次要终点包括：（1）视觉模拟量表评估的下腰部疼痛强度及向下肢放射的疼痛强度；（2）采用Oswestry功能障碍指数和12项简明健康调查问卷评估的临床疗效；（3）手术疗效；（4）并发症。
术后6个月时，采用动态X线片和计算机断层扫描评估的融合率在有骶化和无骶化患者之间无显著差异（P值分别为0.70和0.81），而术后1年时存在显著差异（P值分别为0.04和0.04）。特别是，II型或III型L5骶化患者的融合率显著低于其他类型或无L5骶化的患者。两组之间的疼痛强度、临床和手术疗效以及并发症无显著差异。
II型或III型L5骶化患者在L4-L5 PLIF手术后的融合率可能比I型或无骶化患者更差。
