DE Bonis Pasquale, Chiccoli Michele, Visani Jacopo, Cavallo Michele A, Scerrati Alba
Department of Neurosurgery, S. Anna University Hospital, Ferrara, Italy -
Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy -
J Neurosurg Sci. 2022 Dec;66(6):576-581. doi: 10.23736/S0390-5616.20.04893-6. Epub 2020 Feb 25.
The aim of this prospective comparative study was to assess the functional outcome in two groups of patients suffering from spinal lumbar instability and treated by decompression and stabilization with posterior lumbar interbody fusion using percutaneous pedicle screws (PCT) or a novel technique of divergent pedicle screws insertion using a cortical bone divergent trajectory (CBT). Functional outcome after surgery has been evaluated using Numeric Rating Scale (NRS), Modified Rankin Scale (MRS), Smiley-Webster Scale, and Oswestry Disability Index (ODI).
Seventy-two consecutive patients were treated at our department from February 2013 to February 2018 for one-two levels unstable stenosis with one-year follow-up. Forty-one patients were treated with percutaneous screws and thirty-one patients were treated with divergent cortical bone trajectory screws. Functional outcome and complications were analyzed with logistic regression analysis. No funding was received for this research.
Pain significantly improved in both groups. Charlson Comorbidity Index (CCI≥3) was the only variable associated with increased risk of complications (OR=5.73, P=0.04). Patients with BMI≥27.4 (median value) and patients with percutaneous screws had an increased risk of a worse Smiley-Webster Score (OR=3.675; P=0.029 and OR=3.747; P=0.05, respectively). Patients with BMI≥27.4, patients with percutaneous screws and patients with more comorbidities (CCI≥3) showed a higher risk of presenting severe/crippling Oswestry Disability Index Score (OR=6; P=0.027, OR=10.747; P=0.04 and OR=6.310; P=0.043, respectively).
Cortical bone trajectory screws technique could represent a valid alternative to the traditional percutaneous pedicle screws technique in posterior lumbar interbody fusion.
本前瞻性对照研究旨在评估两组腰椎不稳患者的功能结局，这两组患者均接受减压及后路腰椎椎间融合术联合经皮椎弓根螺钉（PCT）或采用皮质骨发散轨迹（CBT）的新型发散椎弓根螺钉置入技术进行稳定治疗。术后功能结局采用数字评分量表（NRS）、改良Rankin量表（MRS）、斯迈利 - 韦伯斯特量表及Oswestry功能障碍指数（ODI）进行评估。
2013年2月至2018年2月，我科连续收治72例患者，均为一至两个节段的不稳定型狭窄，随访一年。41例患者采用经皮螺钉治疗，31例患者采用皮质骨发散轨迹螺钉治疗。采用逻辑回归分析对功能结局及并发症进行分析。本研究未获得任何资金资助。
两组患者疼痛均显著改善。Charlson合并症指数（CCI≥3）是唯一与并发症风险增加相关的变量（OR = 5.73，P = 0.04）。体重指数（BMI）≥27.4（中位数）的患者及采用经皮螺钉治疗的患者斯迈利 - 韦伯斯特评分较差的风险增加（分别为OR = 3.675；P = 0.029和OR = 3.747；P = 0.05）。BMI≥27.4的患者、采用经皮螺钉治疗的患者及合并症更多（CCI≥3）的患者出现严重/致残性Oswestry功能障碍指数评分的风险更高（分别为OR = 6；P = 0.027，OR = 10.747；P = 0.04和OR = 6.310；P = 0.043）。
在腰椎后路椎间融合术中，皮质骨轨迹螺钉技术可作为传统经皮椎弓根螺钉技术的有效替代方法。
