Department of Orthopedic Surgery, Juntendo University School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
Department of Orthopedic Surgery, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan.
Eur Spine J. 2020 Apr;29(4):879-885. doi: 10.1007/s00586-020-06310-0. Epub 2020 Jan 29.
Lateral lumbar interbody fusion (LLIF) has been performed to correct spinal deformity associated with lumbar degenerative disease. Although its usefulness has been studied, there are no reports of quantitative evaluation in three dimensions. Our purpose is to quantitate 3D deformity of the patients with lumbar degenerative disease and correction of the deformity by LLIF using patient-specific 3D CT models.
We measured the disc height and 3D alignment of the lumbar spine in 28 patients with degenerative disease undergoing LLIF using patient-specific 3D CT models created preoperatively and 3 months after surgery. The 3D alignment was calculated as wedge, lordosis and axial rotation angles at each motion segment. The disc height and the rotational angles were compared between before and after LLIF.
A strong positive correlation was found between the wedge angle and the axial rotation angles (r = 0.718, P < 0.001) in the patients with lumbar degenerative disease preoperatively. The wedge and axial rotation angles decreased after surgery (P < 0.001 and P < 0.001, respectively). A positive correlation was found between the corrected wedge angle and the corrected axial rotation angle (r = 0.46, P < 0.001).
The present study demonstrated positive correlations between the wedge deformity and the axial rotational deformity in the patients with lumbar degenerative disease. The axial rotational deformity was simultaneously corrected with LLIF only by leveling the intervertebral wedge deformity via cage insertion without additional correction procedure. These slides can be retrieved under Electronic Supplementary Material.
经椎间孔腰椎体间融合术（TLIF）已用于矫正与腰椎退行性疾病相关的脊柱畸形。尽管其有效性已得到研究，但尚无关于三维定量评估的报道。我们的目的是使用患者特异性的 3D CT 模型来定量评估腰椎退行性疾病患者的三维畸形，并通过 TLIF 矫正畸形。
我们使用术前和术后 3 个月创建的患者特异性 3D CT 模型，测量了 28 例接受 TLIF 的退行性疾病患者的椎间盘高度和腰椎三维排列。三维排列计算为每个运动节段的楔形角、脊柱前凸角和轴向旋转角。比较 TLIF 前后椎间盘高度和旋转角度的变化。
术前腰椎退行性疾病患者的楔形角与轴向旋转角之间存在很强的正相关关系（r=0.718，P<0.001）。术后楔形角和轴向旋转角减小（P<0.001 和 P<0.001）。校正楔形角和校正轴向旋转角之间存在正相关关系（r=0.46，P<0.001）。
本研究表明，腰椎退行性疾病患者的楔形畸形与轴向旋转畸形之间存在正相关关系。通过椎间楔形畸形的矫正，仅通过插入椎间融合器即可同时矫正轴向旋转畸形，而无需额外的矫正步骤。这些幻灯片可以在电子补充材料中检索。
