Konomi Tsunehiko, Yasuda Akimasa, Fujiyoshi Kanehiro, Yato Yoshiyuki, Asazuma Takashi
Department of Orthopaedic Surgery, Murayama Medical Center, National Hospital Organization, Tokyo, Japan.
Asian Spine J. 2020 Feb;14(1):106-112. doi: 10.31616/asj.2019.0024. Epub 2019 Oct 15.
A retrospective, single-center clinical study with follow-up of more than 24 months.
To evaluate the union rates and relevant risk factors for non-union after posterior lumbar interbody fusion (PLIF) using porous-coated closed-box titanium spacers.
Although the use of a closed-box interbody spacer for PLIF could avoid potential complications associated with the harvesting of autologous bone, few studies have reported detailed follow-up of fusion progression and risk factors for non-union in the early postoperative period.
PLIF using closed-box spacers without filling the autologous bone was performed in 78 (88 levels) consecutive patients. Surgical procedures included PLIF using traditional pedicle screw fixation (PLIF, n=37), PLIF using cortical bone trajectory screw fixation (CBT-PLIF, n=30), and transforaminal lumbar interbody fusion with traditional pedicle screw fixation (TLIF, n=11). Lateral dynamic radiography and computed tomography findings were investigated, and the relationship between the union status and variables that may be related to the risk of non-union was tested statistically.
The overall bone union rates at 12 and 24 months were 68.0% and 88.5%, respectively. Incidences of bone cyst formation, subsidence, and retropulsion of spacers were 33.3%, 47.4%, and 14.1%, respectively. Union rates at 24 months were 94.6% in PLIF, 80.0% in CBT-PLIF, and 90.9% in TLIF. Multivariate logistic regression analyses showed that at 12 months postoperatively, the risk factor for non-union was age >75 years (p =0.02). In contrast, no significant risk factor was observed at 24 months.
These findings demonstrated the efficacy of interbody closed-box spacers for PLIF without the need to fill the spacer with autologous bone. However, the risk of non-union should be considered in elderly patients, especially intra-operatively and during the early postoperative stage.
一项随访时间超过24个月的回顾性单中心临床研究。
评估使用多孔涂层封闭盒式钛椎间融合器进行后路腰椎椎间融合术（PLIF）后的融合率及骨不连相关危险因素。
尽管使用封闭盒式椎间融合器进行PLIF可避免与自体骨采集相关的潜在并发症，但很少有研究报道术后早期融合进展的详细随访情况及骨不连的危险因素。
对78例（88个节段）连续患者进行了不填充自体骨的封闭盒式椎间融合器PLIF手术。手术方式包括传统椎弓根螺钉固定的PLIF（PLIF组，n = 37）、皮质骨轨迹螺钉固定的PLIF（CBT - PLIF组，n = 30）以及传统椎弓根螺钉固定的经椎间孔腰椎椎间融合术（TLIF组，n = 11）。研究了侧位动态X线片和计算机断层扫描结果，并对融合状态与可能与骨不连风险相关的变量之间的关系进行了统计学检验。
12个月和24个月时的总体骨融合率分别为68.0%和88.5%。骨囊肿形成、椎间融合器下沉和后凸的发生率分别为33.3%、47.4%和14.1%。PLIF组、CBT - PLIF组和TLIF组24个月时的融合率分别为94.6%、80.0%和90.9%。多因素逻辑回归分析显示，术后12个月时，骨不连的危险因素为年龄>75岁（p = 0.02）。相比之下，24个月时未观察到显著的危险因素。
这些结果表明，无需在椎间融合器中填充自体骨的封闭盒式椎间融合器用于PLIF是有效的。然而，对于老年患者，尤其是在手术中和术后早期，应考虑骨不连的风险。
