Satake Kotaro, Kanemura Tokumi, Nakashima Hiroaki, Ishikawa Yoshimoto, Segi Naoki, Ouchida Jun
Department of Orthopaedic Surgery, Konan Kosei Hospital, Konan, Japan.
Spine Surg Relat Res. 2018 Apr 7;2(4):270-277. doi: 10.22603/ssrr.2017-0096. eCollection 2018 Oct 26.
This retrospective study was performed to evaluate the clinical influence of - and to identify the risk factors for nonunion of transpsoas lateral lumbar interbody fusion (LLIF) with use of allograft.
Sixty-three patients who underwent transpsoas LLIF (69.8 ± 8.9 years, 21 males and 42 females, 125 segments) were followed for a minimum 2 years postoperatively. For all LLIF segments, polyetheretherketone (PEEK) cages packed with allogenic bone were applied with supplemental bilateral pedicle screws (PSs). Bone bridge formation was evaluated by computed tomography (CT) 2 years postoperative, and a segment without any bridge formation was determined to be a nonunion. Sixty-one participants (96.8%) were classified into two groups for clinical evacuation: Group N that contained one or more nonunion segments and Group F that contained no nonunion segment. Visual analogue scales (VAS) scores and the effective rates of the five domains of the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) were compared between Groups N and F. The risk factors for nonunion were determined by univariate and multivariate analyses.
Twenty segments (16%) were diagnosed as nonunion. There were no significant differences in all VAS scores, and the ratio of effective cases in all domains of JOABPEQ between Group N ( = 14) and F ( = 47). Multivariate analysis identified percutaneous PS (PPS) usage (odds ratio [OR]: 3.14, 95% confidence interval: 1.13-8.68, = 0.028) as a positive risk factor for nonunion.
We should be aware of the higher nonunion rate in the LLIF segments supplemented with PPS, though nonunion does not affect significantly clinical outcomes at 2 years postoperative.
本回顾性研究旨在评估同种异体骨在经腰大肌外侧腰椎椎间融合术（LLIF）中对骨不连的临床影响并确定其危险因素。
对63例行经腰大肌LLIF的患者（年龄69.8±8.9岁，男21例，女42例，共125个节段）进行术后至少2年的随访。所有LLIF节段均应用填充异体骨的聚醚醚酮（PEEK）椎间融合器，并辅以双侧椎弓根螺钉（PS）。术后2年通过计算机断层扫描（CT）评估骨桥形成情况，无任何骨桥形成的节段判定为骨不连。61名参与者（96.8%）根据骨不连情况分为两组进行临床分析：N组包含一个或多个骨不连节段，F组无骨不连节段。比较N组（n = 14）和F组（n = 47）之间的视觉模拟量表（VAS）评分以及日本骨科学会腰痛评估问卷（JOABPEQ）五个领域的有效率。通过单因素和多因素分析确定骨不连的危险因素。
20个节段（16%）被诊断为骨不连。N组（n = 14）和F组（n = 47）在所有VAS评分以及JOABPEQ所有领域的有效病例比例方面均无显著差异。多因素分析确定使用经皮PS（PPS）（比值比[OR]：3.14，95%置信区间：1.13 - 8.68，P = 0.028）为骨不连的阳性危险因素。
我们应注意到使用PPS辅助的LLIF节段骨不连发生率较高，尽管骨不连在术后2年对临床结局无显著影响。
