Department of Orthopedic Surgery, Stanford University School of Medicine, Redwood City, CA.
Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Spine (Phila Pa 1976). 2018 Oct 1;43(19):1372-1380. doi: 10.1097/BRS.0000000000002630.
STUDY DESIGN: This is a retrospective cohort study. OBJECTIVE: To evaluate the long-term outcomes of selective one- to two-level anterior lumbar interbody fusions (ALIFs) in the lower lumbar spine versus continued nonsurgical management. SUMMARY OF BACKGROUND DATA: Low back pain associated with lumbar intervertebral disc degeneration is common with substantial economic impact, yet treatment remains controversial. Surgical fusion has previously provided mixed results with limited durable improvement of pain and function. METHODS: Seventy-five patients with one or two levels of symptomatic Pfirrmann grades 3 to 5 disc degeneration from L3-S1 were identified. All patients had failed at least 6 months of nonsurgical treatment. Forty-two patients underwent one- or two-level ALIFs; 33 continued multimodal nonsurgical care. Patients were evaluated radiographically and the visual analog pain scale (VAS), Oswestry Disability Index (ODI), EuroQol five dimensions (EQ-5D), and Patient-Reported Outcomes Measurement Information System scores for pain interference, pain intensity, and anxiety. As-treated analysis was performed to evaluate outcomes at a mean follow-up of 7.4 years (range: 2.5-12). RESULTS: There were no differences in pretreatment demographics or nonsurgical therapy utilization between study arms. At final follow-up, the surgical arm demonstrated lower VAS, ODI, EQ-5D, and Patient-Reported Outcomes Measurement Information System pain intensity scores versus the nonsurgical arm. VAS and ODI scores improved 52.3% and 51.1% in the surgical arm, respectively, versus 15.8% and -0.8% in the nonsurgical arm. Single-level fusions demonstrated improved outcomes versus two-level fusions. The pseudarthrosis rate was 6.5%, with one patient undergoing reoperation. Asymptomatic adjacent segment degeneration was identified in 11.9% of patients. CONCLUSION: Selective ALIF limited to one or two levels in the lower lumbar spine provided improved pain and function when compared with continued nonsurgical care. ALIF may be a safe and effective treatment for low back pain associated with disc degeneration in select patients who fail nonsurgical management. LEVEL OF EVIDENCE: 3.
研究设计：这是一项回顾性队列研究。 目的：评估选择性单至双节段前路腰椎间融合术（ALIF）治疗下腰椎与继续非手术治疗的长期结果。 背景资料概要：与腰椎间盘退变相关的腰痛很常见，且具有重大的经济影响，但治疗仍存在争议。手术融合先前提供了混合结果，对疼痛和功能的改善有限且持久。 方法：从 L3-S1 共确定了 75 例有 1 或 2 个症状性 Pfirrmann 分级 3 至 5 级椎间盘退变的患者。所有患者均经至少 6 个月的非手术治疗失败。42 例患者行单或双节段 ALIF；33 例继续多模式非手术治疗。对患者进行影像学评估，并使用视觉模拟疼痛量表（VAS）、Oswestry 残疾指数（ODI）、EuroQol 五维健康量表（EQ-5D）和患者报告的结局测量信息系统（PROMIS）评分评估疼痛干扰、疼痛强度和焦虑程度。进行按治疗分析，以评估平均随访 7.4 年（范围：2.5-12 年）的结果。 结果：研究组间在治疗前人口统计学或非手术治疗利用方面无差异。在最终随访时，手术组的 VAS、ODI、EQ-5D 和 PROMIS 疼痛强度评分均低于非手术组。手术组的 VAS 和 ODI 评分分别改善了 52.3%和 51.1%，而非手术组则分别改善了 15.8%和-0.8%。单节段融合术的疗效优于双节段融合术。假关节形成率为 6.5%，1 例患者再次手术。发现无症状的相邻节段退变占 11.9%的患者。 结论：与继续非手术治疗相比，选择性下腰椎单至双节段 ALIF 可改善疼痛和功能。对于经非手术治疗失败的选择患者，ALIF 可能是一种安全有效的治疗方法，可用于治疗与椎间盘退变相关的腰痛。 证据等级：3。
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