Zhao Yiwei, Jia Jun, Liu Wubo, Chen Xi, Mai Ruopeng, Tian Yonghao, Zhao Jiang, Liu Xinyu
Shandong University Cheeloo College of Medicine, Wenhua West Road 44#, Jinan, Shandong Province, 250012, PR China.
Department of Orthopedics, Qilu Hospital of Shandong University, Wenhua West Road 107#, Jinan, Shandong Province, 250012, PR China.
J Orthop Sci. 2020 Jan;25(1):89-95. doi: 10.1016/j.jos.2019.03.008. Epub 2019 Mar 29.
Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is among the most commonly performed surgical procedure to treat lumbar degenerative disorders. In open TLIF procedure, usually rods were contoured to restore normal lumbar sagittal alignment. However, in MIS-TLIF procedure, contoured rods sometimes were easier to rotate and harder to be locked at the satisfactory position due to instrumentation design and limited exposure. Thus, straight rods had been used in single-level MIS-TLIF in our institution. However, the effect of rod contouring on sagittal parameters and clinical outcomes remains unclear. In the present study, we aim to evaluate the effects of single-segment MIS-TLIF with contoured versus straight rods on sagittal parameters and clinical outcomes.
A retrospective review of MIS-TLIF at L4/5 was performed between 2009 and 2013 in our hospital. Seventy-six cases were divided into contoured rod group (CR group, n = 35) and straight rod group (SR group, n = 41). Clinical outcomes and radiographic measurements at five years' follow-up were evaluated by visual analog score (VAS), Oswestry disability index (ODI) and Japanese Orthopaedic Association (JOA) score, spino-pelvic parameters, disc height and fused segment angle. Fusion rate and cage subsidence were also measured.
Preoperative VAS, JOA, ODI and radiographic parameters were comparable between two groups. The average follow-up was 63.72 ± 3.86 months. VAS, JOA and ODI were significantly improved at 5-year follow-up in both groups, and there were no significant differences between two groups(P > 0.05). Fused segment angle (FSA) was greater in CR group than SR group (P = 0.024), while the other radiographic parameters were not significantly different(P > 0.05). Rod process, fusion rate and cage subsidence were not risk factors of post-surgical malalignment, patients with pre-surgical sagittal imbalance was more prone to show post-surgical malalignment (P < 0.05).
Both CR and SR groups acquired satisfactory clinical results. Although contoured rods had better fused segment angle, contoured or straight rods at single L4/5 level had little effect on global spino-pelvic parameters and clinical outcomes in a 5-year follow-up.
微创经椎间孔腰椎椎体间融合术（MIS-TLIF）是治疗腰椎退行性疾病最常用的外科手术之一。在开放TLIF手术中，通常对棒进行塑形以恢复正常的腰椎矢状位对线。然而，在MIS-TLIF手术中，由于器械设计和暴露有限，塑形棒有时更容易旋转且难以锁定在满意的位置。因此，在我们机构的单节段MIS-TLIF手术中使用了直棒。然而，棒的塑形对矢状位参数和临床结果的影响仍不清楚。在本研究中，我们旨在评估单节段MIS-TLIF使用塑形棒与直棒对矢状位参数和临床结果的影响。
对2009年至2013年在我院进行的L4/5节段MIS-TLIF手术进行回顾性研究。76例患者分为塑形棒组（CR组，n = 35）和直棒组（SR组，n = 41）。通过视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）和日本骨科协会（JOA）评分、脊柱骨盆参数、椎间盘高度和融合节段角度评估5年随访时的临床结果和影像学测量。还测量了融合率和椎间融合器下沉情况。
两组术前的VAS、JOA、ODI和影像学参数具有可比性。平均随访时间为63.72 ± 3.86个月。两组在5年随访时VAS、JOA和ODI均有显著改善，两组间无显著差异（P > 0.05）。CR组的融合节段角度（FSA）大于SR组（P = 0.024），而其他影像学参数无显著差异（P > 0.05）。棒的操作、融合率和椎间融合器下沉不是术后畸形的危险因素，术前矢状位失衡患者更易出现术后畸形（P < 0.05）。
CR组和SR组均获得了满意的临床结果。虽然塑形棒的融合节段角度更好，但在L4/5单节段水平，塑形棒或直棒在5年随访中对整体脊柱骨盆参数和临床结果影响不大。
