有限腰椎间盘切除术后结合或不结合骨锚定环形闭合对椎体终板改变的形态学和临床相关性。
Morphology and Clinical Relevance of Vertebral Endplate Changes Following Limited Lumbar Discectomy With or Without Bone-anchored Annular Closure.
机构信息
Department of Neurosurgery, Donauisar Klinikum Deggendorf, Deggendorf, Germany.
Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland.
出版信息
Spine (Phila Pa 1976). 2018 Oct 15;43(20):1386-1394. doi: 10.1097/BRS.0000000000002632.
STUDY DESIGN
Post hoc analysis of a randomized controlled trial.
OBJECTIVE
To characterize the morphology and clinical relevance of vertebral endplate changes (VEPC) following limited lumbar discectomy with or without implantation of a bone-anchored annular closure device (ACD).
SUMMARY OF BACKGROUND DATA
Implantation of an ACD following limited lumbar discectomy has shown promise in reducing the risk of recurrent herniation in patients with large annular defects. However, the interaction between the ACD and the lumbar endplate over time is not well understood.
METHODS
Patients undergoing limited lumbar discectomy with large postsurgical annular defects were randomized intraoperatively to receive additional ACD implantation or limited lumbar discectomy only (Controls). VEPC morphology, area, and volume were assessed with low-dose computed tomography preoperatively and at 1 and 2 years follow-up.
RESULTS
Of 554 randomized patients, the as-treated population consisted of 550 patients (267 ACD, 283 Controls). VEPC were preoperatively identified in 18% of patients in the ACD group and in 15% of Controls. At 2 years, VEPC frequency increased to 85% with ACD and 33% in Controls. Device- or procedure-related serious adverse event (8% vs. 17%, P = 0.001) and secondary surgical intervention (5% vs. 13%, P < 0.001) favored the ACD group over Controls. In the ACD group, clinical outcomes were comparable in patients with and without VEPC at 2 years follow-up. In the Control group, patients with VEPC at 2 years had higher risk of symptomatic reherniation versus patients without VEPC (35% vs. 19%, P < 0.01) CONCLUSION.: In patients with large annular defects following limited lumbar discectomy, additional implantation with a bone-anchored ACD reduces risk of postoperative complications despite a greater frequency of VEPC. VEPC were associated with higher risk of symptomatic reherniation in patients treated with limited lumbar discectomy, but not in those who received additional ACD implantation.
LEVEL OF EVIDENCE
研究设计
随机对照试验的事后分析。
目的
描述有限腰椎间盘切除术联合或不联合骨锚定环形闭合装置（ACD）植入术后椎体终板变化（VEPC）的形态和临床相关性。
背景资料概要
在存在大的环形缺损的患者中，有限腰椎间盘切除术后植入 ACD 显示出降低复发疝风险的潜力。然而，随着时间的推移，ACD 与腰椎终板之间的相互作用尚不清楚。
方法
对接受大的术后环形缺损的有限腰椎间盘切除术的患者进行术中随机分组，分别接受额外的 ACD 植入或仅接受有限腰椎间盘切除术（对照组）。在术前和 1 年、2 年随访时，使用低剂量 CT 评估 VEPC 的形态、面积和体积。
结果
在 554 例随机患者中，实际处理人群由 550 例患者组成（267 例 ACD，283 例对照组）。在 ACD 组中有 18%的患者和对照组中有 15%的患者术前发现有 VEPC。2 年后，VEPC 的发生率在 ACD 组增加到 85%，在对照组中增加到 33%。与对照组相比，与器械或手术相关的严重不良事件（8%比 17%，P=0.001）和二次手术干预（5%比 13%，P<0.001）更有利于 ACD 组。在 ACD 组中，在 2 年随访时，VEPC 组和无 VEPC 组的临床结果相当。在对照组中，2 年后有 VEPC 的患者发生症状性再疝的风险高于无 VEPC 的患者（35%比 19%，P<0.01）。
结论
在接受有限腰椎间盘切除术治疗的大环形缺损患者中，尽管术后 VEPC 发生率较高，但联合使用骨锚定 ACD 可降低术后并发症的风险。VEPC 与接受有限腰椎间盘切除术的患者发生症状性再疝的风险增加有关，但与接受额外 ACD 植入的患者无关。
证据水平
2 级。
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