Kremer M Adam, Alferink Jefferson, Wynsma Stacie, Shirk Torrey, Ledonio Charles
The Brain and Spine Center, Holland, MI, USA.
Globus Medical, Inc., Audubon, PA, USA.
J Spine Surg. 2019 Sep;5(3):315-319. doi: 10.21037/jss.2019.06.07.
Transforaminal lumbar interbody fusion is an effective and frequently performed surgical treatment of chronic lower back pain. Expandable interbody spacers are designed to create greater disc height through expansion. It remains unclear whether the benefits of expandable technology will translate into clinical benefits. The current study compares expandable to static interbody spacers.
This is a retrospective study of 99 patients (48 static and 51 expandable) at a single site. Radiographs were collected preoperatively and at 3 months postoperatively. Standard of care at this site requires radiographs to be taken past 3 months only if patients are suffering from a severe recurrence of symptoms. Patient reported outcomes, Oswestry disability index (ODI) and visual analog scale (VAS), were collected preoperatively, at 1 and 3 months postoperatively. Patients were contacted by the surgeon and patient reported outcomes were collected at a final time point. Average final follow-up for was 67.1±16.3 months and for expandable patients it was 43.0±4.2 months.
At 3 months postoperatively and at final follow-up, patients treated with expandable interbody spacers had significantly lower average ODI scores than patients with static interbody spacers. Both groups reported significant reductions in VAS scores through all follow-up. At 4 years postoperative 8 static group patients and 3 expandable group patients returned for recurrence of symptoms.
Expandable interbody spacers in this study were found to be comparable to static interbody spacers, with improvements in VAS and ODI scores.
经椎间孔腰椎椎间融合术是治疗慢性下腰痛的一种有效且常用的外科手术。可扩张椎间融合器旨在通过扩张来增加椎间盘高度。可扩张技术的益处是否能转化为临床益处仍不明确。本研究比较了可扩张椎间融合器与静态椎间融合器。
这是一项对单个机构99例患者（48例使用静态融合器，51例使用可扩张融合器）的回顾性研究。术前及术后3个月收集X线片。该机构的护理标准要求，仅当患者出现严重症状复发时才在术后3个月后拍摄X线片。术前、术后1个月和3个月收集患者报告的结果、Oswestry功能障碍指数（ODI）和视觉模拟量表（VAS）。外科医生与患者联系，并在最终时间点收集患者报告的结果。静态融合器组患者的平均最终随访时间为67.1±16.3个月，可扩张融合器组患者为43.0±4.2个月。
术后3个月及最终随访时，使用可扩张椎间融合器治疗的患者平均ODI评分显著低于使用静态椎间融合器的患者。两组在所有随访中VAS评分均显著降低。术后4年，静态融合器组有8例患者、可扩张融合器组有3例患者因症状复发返回。
本研究发现可扩张椎间融合器与静态椎间融合器效果相当，VAS和ODI评分均有所改善。
