Lee Dong-Yeong, Park Young-Jin, Song Sang-Youn, Jeong Soon-Taek, Kim Dong-Hee
Department of Orthopaedic Surgery, The Armed Forces Daegu Hospital, Gyeongsan, Korea.
Department of Orthopaedic Surgery, Research Institute of Clinical Medicine, Institute of Health Sciences, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea.
Asian Spine J. 2018 Feb;12(1):59-68. doi: 10.4184/asj.2018.12.1.59. Epub 2018 Feb 7.
A retrospective clinical case series.
To determine the strength of association between cage retropulsion and its related factors.
Lumbar interbody fusion with cage can obtain a firm union and can restore the disc height with normal sagittal and coronal alignment. Although lumbar interbody fusion procedures have satisfactory clinical outcomes, peri- and postoperative complications regarding the cage remain challenging.
From January 2006 to June 2016, 1,047 patients with lumbar degenerative disc disease who underwent posterior lumbar interbody fusion or transforaminal interbody fusion at Gyeongsang National University Hospital were enrolled. Medical records and pre- and postoperative radiographs were reviewed to identify significant cage retropulsion-related factors. The associations between cage retropulsion with various risk factors were evaluated by calculating odds ratios (ORs) and 95% confidence intervals (CIs) using multiple logistic regression analysis.
Of 1,229 disc levels, 16 cases (1.3%, 10 men and 6 women) had cage retropulsion. Univariate analysis revealed no significant differences between the cage retropulsion group and the no cage retropulsion group with regard to demographic data such as age, sex, weight, height, body mass index (BMI), smoking habits, presence of osteoporosis, and duration of follow-up. Multivariate analysis revealed that low BMI (OR, 0.875; 95% CI, 0.771-0.994; =0.040), presence of screw loosening (OR, 27.400; 95% CI, 7.818-96.033; <0.001), and pear-shaped disc (OR, 9.158; 95% CI, 2.455-34.160; =0.001) were significantly associated with cage retropulsion.
This study demonstrated that low BMI, loosening of posterior instrumentation, and pear-shaped disc were associated with cage retropulsion after lumbar interbody fusion. Therefore, when performing lumbar interbody fusion with a cage, surgeons should have skillful surgical techniques for firm fixation to prevent cage retropulsion, particularly in non-obese patients.
一项回顾性临床病例系列研究。
确定椎间融合器后移与其相关因素之间的关联强度。
使用椎间融合器进行腰椎椎间融合可实现牢固融合，并能恢复椎间盘高度以及矢状面和冠状面的正常排列。尽管腰椎椎间融合手术具有令人满意的临床效果，但与椎间融合器相关的围手术期和术后并发症仍然具有挑战性。
纳入2006年1月至2016年6月期间在庆尚国立大学医院接受后路腰椎椎间融合术或经椎间孔椎间融合术的1047例腰椎退行性椎间盘疾病患者。回顾病历以及术前和术后的X线片，以确定与椎间融合器后移相关的重要因素。使用多因素逻辑回归分析计算比值比（OR）和95%置信区间（CI），评估椎间融合器后移与各种危险因素之间的关联。
在1229个椎间盘节段中，16例（1.3%，男性10例，女性6例）出现椎间融合器后移。单因素分析显示，在年龄、性别、体重、身高、体重指数（BMI）、吸烟习惯、骨质疏松症的存在以及随访时间等人口统计学数据方面，椎间融合器后移组与无椎间融合器后移组之间无显著差异。多因素分析显示，低BMI（OR，0.875；95%CI，0.771 - 0.994；P = 0.040）、螺钉松动的存在（OR，27.400；95%CI，7.818 - 96.033；P < 0.001）以及梨形椎间盘（OR，9.158；95%CI，2.455 - 34.160；P = 0.001）与椎间融合器后移显著相关。
本研究表明低BMI、后路内固定松动以及梨形椎间盘与腰椎椎间融合术后椎间融合器后移有关。因此，在使用椎间融合器进行腰椎椎间融合时，外科医生应具备熟练的手术技术以实现牢固固定，以防止椎间融合器后移，尤其是在非肥胖患者中。
