可扩张椎间融合器在腰椎融合中的疗效：系统评价和荟萃分析。

Outcomes of Expandable Interbody Devices in Lumbar Fusion: A Systematic Review and Meta-analysis.

机构信息

Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.

出版信息

Clin Spine Surg. 2020 Jul;33(6):230-243. doi: 10.1097/BSD.0000000000000959.

DOI:10.1097/BSD.0000000000000959

PMID:32101992

Abstract

STUDY DESIGN

This was a systematic review.

OBJECTIVE

The objective of this study was to review radiographic, clinical, and surgical outcomes of expandable interbody device implantation following lumbar fusion.

SUMMARY OF BACKGROUND DATA

Few studies have evaluated postsurgical outcomes of expandable implants following lumbar interbody fusion.

METHODS

A systematic review was performed to identify studies investigating expandable intervertebral body devices in lumbar fusion. Radiographic parameters, fusion assessments, patient-reported outcomes (PROs), complications, and revision data were recorded. A comparison of expandable and static devices was performed using a meta-analysis.

RESULTS

Eleven articles were included. Postoperative improvements for each radiographic parameters for expandable versus static device implantation ranged from: lumbar lordosis, +2.0 to +5.0 degrees (expandable) versus +1.0 to +4.4 degrees (static); segmental lordosis, +1.0 to +5.2 degrees (expandable) versus+1.1 to +2.3 degrees (static); disk height, +0.82 to +4.8 mm (expandable) versus +0.26 to +6.9 mm (static); foraminal height, +0.13 to +2.8 mm (expandable) versus and +0.05 to +3.0 mm (static). Fusion rates ranged from 72.1% at 6 months to 100% at terminal follow-up. Preoperative to final follow-up improvement for the various PROs assessed were: Oswestry Disability Index, -15.4 to -56.3 (expandable) versus -13.6 to -26.3 (static); Visual Analog Scale (VAS) Back, -3.2 to -6.0 (expandable) versus -3.1 to -4.1 (static); and VAS Leg, -2.9 to -7.1 (expandable) -3.0 versus -4.8 (static). Static cages had a reported complication rate ranging from 6.0% to 16.1% and a subsidence rate of 6.0%. Expandable cages had a reported complication rate that ranged from 0.0.% to 10.0% and a subsidence rate of 5.5%-10.0%. A meta-analysis demonstrated a statistically significant difference in the PRO Oswestry Disability Index, but not VAS Back, VAS Leg, or radiographic outcomes (disk height or foraminal height).

CONCLUSION

There is no clear evidence for the use of expandable interbody devices over static devices.

摘要

研究设计

这是一项系统评价。

目的

本研究的目的是回顾腰椎融合术后可扩张椎间植入物的影像学、临床和手术结果。

背景资料概要

很少有研究评估腰椎间融合术后可扩张植入物的术后结果。

方法

进行了系统评价，以确定研究可扩张椎体间装置在腰椎融合中的应用。记录影像学参数、融合评估、患者报告的结果 (PRO)、并发症和翻修数据。使用荟萃分析比较了可扩张和静态装置。

结果

共纳入 11 篇文章。与静态器械植入相比，可扩张器械植入的每个影像学参数的术后改善范围为：腰椎前凸，+2.0 至+5.0 度（可扩张）与+1.0 至+4.4 度（静态）；节段前凸，+1.0 至+5.2 度（可扩张）与+1.1 至+2.3 度（静态）；椎间盘高度，+0.82 至+4.8mm（可扩张）与+0.26 至+6.9mm（静态）；椎间孔高度，+0.13 至+2.8mm（可扩张）与+0.05 至+3.0mm（静态）。融合率从 6 个月时的 72.1%到最终随访时的 100%。各种 PRO 评估的术前至最终随访改善情况为：Oswestry 功能障碍指数，-15.4 至-56.3（可扩张）与-13.6 至-26.3（静态）；视觉模拟量表 (VAS) 背部，-3.2 至-6.0（可扩张）与-3.1 至-4.1（静态）；和 VAS 腿部，-2.9 至-7.1（可扩张）-3.0 与-4.8（静态）。静态笼的并发症发生率为 6.0%至 16.1%，沉降率为 6.0%。可扩张笼的并发症发生率为 0.0%至 10.0%，沉降率为 5.5%-10.0%。荟萃分析显示，PRO Oswestry 功能障碍指数存在统计学显著差异，但 VAS 背部、VAS 腿部或影像学结果（椎间盘高度或椎间孔高度）无差异。