复杂成人脊柱畸形手术中的神经损伤：使用超前凸钽笼行分期多节段斜向腰椎间融合术（MOLIF）与经椎弓根截骨术（PSO）的后路融合比较
Neurologic Injury in Complex Adult Spinal Deformity Surgery: Staged Multilevel Oblique Lumbar Interbody Fusion (MOLIF) Using Hyperlordotic Tantalum Cages and Posterior Fusion Versus Pedicle Subtraction Osteotomy (PSO).
机构信息
Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, London, UK.
The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China.
出版信息
Spine (Phila Pa 1976). 2019 Aug 15;44(16):E939-E949. doi: 10.1097/BRS.0000000000003034.
STUDY DESIGN
A retrospective review of prospectively collected data.
OBJECTIVE
The aim of this study was to determine the safety of MOLIF versus PSO.
SUMMARY OF BACKGROUND DATA
Complex adult spinal deformity (CASD) represents a challenging cohort of patients. The Scoli-RISK-1 study has shown a 22.18% perioperative risk of neurological injury. Restoration of sagittal parameters is associated with good outcome in ASD. Pedicle subtraction osteotomies (PSO) is an important technique for sagittal balance in ASD but is associated with significant morbidity. The multilevel oblique lumbar interbody fusion (MOLIF) is an extensile approach from L1 to S1.
METHODS
Single surgeon series from 2007 to 2015. Prospectively collected data. Scoli-RISK-1 criteria were refined to only include stiff or fused spines otherwise requiring a PSO. Roentograms were examined preoperatively and 2 year postoperatively. Primary outcome measure was the motor decline in American Spinal Injury Association (ASIA) at hospital discharge, 6 weeks, 6 months, and 2 years. Demographics, blood loss, operative time, spinopelvic parameters, and spinal cord monitoring (SCM) events.
RESULTS
Sixty-eight consecutive patients were included in this study, with 34 patients in each Group. Group 1 (MOLIF) had a mean age 62.9 (45-81) and Group 2 (PSO) had a mean age of 66.76 years (47-79); 64.7% female versus PSO 76.5%; Body Mass Index (BMI) Group 1 (MOLIF) 28.05 and Group 2 (PSO) 27.17. Group 1 (MOLIF) perioperative neurological injury was 2.94% at discharge but resolved by 6 weeks. Group 2 (PSO) had five neurological deficits (14.7%) with no recovery by 2 years. There were four SCM events (SCM). In Group 1 (MOLIF), there was one event (2.94%) versus three events (8.88%) in Group 2 (PSO).
CONCLUSION
Staged MOLIF avoids passing neurological structures or retraction of psoas and lumbar plexus. It is safer than PSO in CASD with stiff or fused spines with a lower perioperative neurological injury profile. MOLIF have less SCM events, blood loss, and number of levels fused.
LEVEL OF EVIDENCE
研究设计
前瞻性数据回顾。
目的
本研究旨在确定 MOLIF 与 PSO 的安全性。
背景资料概要
复杂的成人脊柱畸形（CASD）代表了一组具有挑战性的患者。Scoli-RISK-1 研究显示，围手术期神经损伤的风险为 22.18%。在 ASD 中，矢状参数的恢复与良好的结果相关。椎弓根切除截骨术（PSO）是 ASD 中矢状平衡的重要技术，但与显著的发病率相关。多节段斜向腰椎椎间融合术（MOLIF）是一种从 L1 到 S1 的广泛应用的方法。
方法
2007 年至 2015 年的单外科医生系列。前瞻性收集数据。Scoli-RISK-1 标准经过修订，仅包括僵硬或融合的脊柱，否则需要 PSO。术前和术后 2 年拍摄 X 光片。主要观察指标是美国脊柱损伤协会（ASIA）在出院、6 周、6 个月和 2 年时的运动功能下降。人口统计学、失血量、手术时间、脊柱骨盆参数和脊髓监测（SCM）事件。
结果
本研究共纳入 68 例连续患者，每组 34 例。第 1 组（MOLIF）的平均年龄为 62.9 岁（45-81 岁），第 2 组（PSO）的平均年龄为 66.76 岁（47-79 岁）；64.7%为女性，而 PSO 为 76.5%；体重指数（BMI）第 1 组（MOLIF）为 28.05，第 2 组（PSO）为 27.17。第 1 组（MOLIF）术后神经损伤发生率为 2.94%，但在 6 周内恢复。第 2 组（PSO）有 5 例神经功能缺损（14.7%），2 年内无恢复。有 4 例 SCM 事件（SCM）。在第 1 组（MOLIF）中，有 1 例（2.94%），而在第 2 组（PSO）中有 3 例（8.88%）。
结论
分期 MOLIF 避免了通过神经结构或腰大肌和腰丛的牵拉。与僵硬或融合的脊柱相比，它比 PSO 更安全，具有更低的围手术期神经损伤特征。MOLIF 的 SCM 事件、失血量和融合节段数更少。
证据水平
3 级。
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