微创经椎间孔腰椎体间融合术后患者发生 cage 沉降的危险因素。

Risk Factors of Cage Subsidence in Patients Received Minimally Invasive Transforaminal Lumbar Interbody Fusion.

机构信息

Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taiwan, ROC.

Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.

出版信息

Spine (Phila Pa 1976). 2020 Oct 1;45(19):E1279-E1285. doi: 10.1097/BRS.0000000000003557.

DOI:10.1097/BRS.0000000000003557

PMID:32472823

Abstract

STUDY DESIGN

A retrospective cohort study.

OBJECTIVE

To determine the risk factors of cage subsidence in patients undergoing minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) and its correlation with patient-reported outcomes.

SUMMARY OF BACKGROUND DATA

Cage subsidence is among the cage-related complications after TLIF and may lead to poor outcomes. Few studies have addressed the incidence of cage subsidence in MI-TLIF.

METHODS

This retrospective study of a prospectively collected database was conducted from October 2015 to October 2017. All patients received MI-TLIF with a minimum of 2-year follow-up. All levels were separated into the cage subsidence (CS group) and no cage subsidence (non-CS group) groups. Cage subsidence was evaluated using lateral radiographs and defined as more than 2 mm migration of the cage into the endplate of adjacent vertebral body. Patient demographics, perioperative details, and radiographic parameters were recorded. Cage-related parameters were cage height, cage insertion level, and cage position. Cage position was recorded using central point ration (CPR). Patient-reported outcome was analyzed using the Oswestry Disability Index (ODI) questionnaire and Visual Analog Scale (VAS) preoperatively and at 2 years postoperatively.

RESULTS

Ninety-three patients (126 levels) were included. Mean age was 66.5 years with an average follow-up of 36.9 months. Overall incidence of cage subsidence was 34.1%. The CS group had significantly higher body mass index, less bone mineral density (BMD), shorter disc height, and higher CPR than the non-CS group. BMD, disc height, and CPR were significantly negatively correlated with depth of cage subsidence. ODI improvement was significantly lesser in the CS group than in the non-CS group. Fusion rate and complications were unrelated to cage subsidence.

CONCLUSION

The BMD, disc height, and cage position were the most significant risk factors that were negatively correlated with depth of cage subsidence. Placing a TLIF cage anteriorly if possible may reduce the risk of cage subsidence.

LEVEL OF EVIDENCE

摘要

研究设计

回顾性队列研究。

目的

确定微创经椎间孔腰椎体间融合术（MI-TLIF）患者中 cage 下沉的危险因素及其与患者报告结果的相关性。

背景资料概要

Cage 下沉是 TLIF 后与 cage 相关的并发症之一，可能导致不良结果。很少有研究涉及 MI-TLIF 中 cage 下沉的发生率。

方法

本研究为前瞻性收集数据库的回顾性研究，于 2015 年 10 月至 2017 年 10 月进行。所有患者均接受 MI-TLIF 治疗，随访时间至少 2 年。所有节段分为 cage 下沉（CS 组）和无 cage 下沉（非 CS 组）两组。通过侧位 X 线片评估 cage 下沉，定义为 cage 向相邻椎体终板迁移超过 2mm。记录患者人口统计学、围手术期细节和影像学参数。Cage 相关参数包括 cage 高度、cage 插入水平和 cage 位置。使用中心点比（CPR）记录 cage 位置。术前和术后 2 年使用 Oswestry 残疾指数（ODI）问卷和视觉模拟评分（VAS）分析患者报告的结果。

结果

共纳入 93 例患者（126 个节段）。平均年龄为 66.5 岁，平均随访时间为 36.9 个月。总体 cage 下沉发生率为 34.1%。CS 组的 BMI、骨密度（BMD）较低，椎间盘高度较短，CPR 较高。BMD、椎间盘高度和 CPR 与 cage 下沉深度呈显著负相关。CS 组的 ODI 改善明显小于非 CS 组。融合率和并发症与 cage 下沉无关。