Department of Orthopedic Surgery, Japan Community Health Care Organization Osaka Hospital, Osaka.
Department of Orthopedic Surgery, Nishinokyo Hospital, Nara, Japan.
Clin Spine Surg. 2020 Dec;33(10):E512-E518. doi: 10.1097/BSD.0000000000001005.
This was a retrospective study.
The purposes of this study were to investigate the fusion rate and clinical outcomes of 2-level posterior lumbar interbody fusion (PLIF).
PLIF provides favorable clinical outcomes and a high fusion rate. However, most extant studies have been limited to the results of single-level PLIF. Clinical outcomes and fusion rate of 2-level PLIF are unknown.
In total, 73 patients who underwent 2-level PLIF below L3 between 2008 and 2016 (follow-up period >2 y) were included. Patients were divided into the 2 groups on the basis of surgical level. The lumbar group included 48 patients who underwent L3/4/5 PLIF, and the lumbosacral group included 25 patients who underwent L4/5/S PLIF. Fusion rate and clinical outcomes were compared. The Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and a visual analog scale were used for evaluation.
Fusion rate was significantly lower in the lumbosacral group (lumbar 96% vs. lumbosacral 64%; P<0.001). Eight of 9 cases of pseudarthrosis occurred at the lumbosacral segment. Improvement in the mental health domain of the JOAPEQ was significantly lower in the lumbosacral group (lumbar 16 vs. lumbosacral 10; P=0.02). The VAS data showed that improvements in the following variables were significantly lower in the lumbosacral group than in the lumbar group: pain in low back (lumbar -38 vs. lumbosacral -23; P=0.004), pain in buttocks or lower leg (lumbar -48 vs. lumbosacral -29; P=0.04), and numbness in buttocks or lower leg (lumbar -44 vs. lumbosacral -33; P=0.04).
Two-level PLIF at the lumbosacral segment demonstrated a significantly lower fusion rate and poorer clinical outcomes than that at the lumbar-only segments. Some reinforcement for the sacral anchor is recommended to improve fusion rate, even for short fusion like 2-level PLIF, if the lumbosacral segment is included.
Level III.
这是一项回顾性研究。
本研究的目的是探讨 2 节段后路腰椎间融合术（PLIF）的融合率和临床结果。
PLIF 可提供良好的临床结果和高融合率。然而，大多数现有研究仅限于单节段 PLIF 的结果。2 节段 PLIF 的临床结果和融合率尚不清楚。
共纳入 2008 年至 2016 年期间接受 2 节段 L3 以下 PLIF（随访时间>2 年）的 73 例患者。根据手术节段，患者分为两组。腰椎组 48 例，行 L3/4/5 PLIF；腰骶段组 25 例，行 L4/5/S PLIF。比较融合率和临床结果。采用日本矫形协会腰痛评估问卷（JOABPEQ）和视觉模拟评分法进行评估。
腰骶段组融合率明显较低（腰椎 96% vs. 腰骶段 64%；P<0.001）。9 例假关节中有 8 例发生在腰骶段。腰骶段组 JOAPEQ 心理健康领域的改善明显低于腰椎组（腰椎 16 分 vs. 腰骶段 10 分；P=0.02）。VAS 数据显示，腰骶段组以下变量的改善明显低于腰椎组：腰痛（腰椎-38 分 vs. 腰骶段-23 分；P=0.004）、臀部或下肢疼痛（腰椎-48 分 vs. 腰骶段-29 分；P=0.04）和臀部或下肢麻木（腰椎-44 分 vs. 腰骶段-33 分；P=0.04）。
腰骶段 2 节段 PLIF 的融合率和临床结果明显低于仅腰椎节段。如果包括腰骶段，建议对骶骨锚点进行一些加固，以提高融合率，即使是 2 节段 PLIF 等短节段融合。
III 级。
