Li Yan Michael, Frisch Richard Francis, Huang Zheng, Towner James Edward, Li Yan Icy, Edsall Amber Lynn, Ledonio Charles
Department of Neurosurgery and Oncology, Medical Center, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA.
Southeastern Spine Institute, Mt. Pleasant, SC, USA.
Asian Spine J. 2021 Feb;15(1):89-96. doi: 10.31616/asj.2019.0260. Epub 2020 Jun 12.
Retrospective chart review.
This study compared the clinical and radiographic outcomes of patients treated with expandable and static interbody spacers following minimally invasive lateral lumbar interbody fusion (MIS-LLIF) with 12-month follow-up.
A common surgical option for the treatment of degenerative disk disease (DDD) is MIS-LLIF using static or expandable spacers to restore disk height (DH), neuroforaminal height (NH), and segmental lordosis. Static spacers may require excessive trialing and aggressive impaction, potentially leading to endplate disruption and subsidence. Expandable spacers allow for in situ expansion to help address complications associated with static spacers.
This is an Institutional Review Board-exempt review of 69 patients (static, n=32; expandable, n=37) diagnosed with DDD who underwent MIS-LLIF at 1-2 contiguous level(s) using static or expandable spacers. Radiographic and clinical outcomes were collected and compared at pre- and postoperative time points up to 12 months.
The expandable group had a significantly higher mean change in Visual Analog Scale (VAS) scores at 6 weeks, 6 months, and 12 months vs. static (∆VAS at 12 months: expandable, 6.7±1.3; static, 5.1±2.6). Mean improvement of Oswestry Disability Index (ODI) scores at 3, 6, and 12 months were significantly better for the expandable group vs. static (∆ODI at 12 months: expandable, 63.2±13.2; static, 29.8±23.4). Mean DH and NH significantly increased at final follow-up for both groups, with no significant difference in DH improvement between groups. The expandable mean NH improvement at 6 weeks and 6 months was significantly greater vs. static. Segmental lordosis significantly improved in the expandable group at all time intervals vs static. Subsidence rate at 12 months was significantly lower in the expandable group (1/46, 2.2%) vs. static (12/37, 32.4%).
Expandable spacers resulted in a significantly lower subsidence rate, improve segmental lordosis, and VAS and ODI outcomes at 12 months vs. static.
回顾性图表审查。
本研究比较了在微创外侧腰椎椎间融合术（MIS-LLIF）后使用可扩张和静态椎间融合器治疗的患者的临床和影像学结果，并进行了12个月的随访。
治疗退行性椎间盘疾病（DDD）的一种常见手术选择是使用静态或可扩张融合器的MIS-LLIF，以恢复椎间盘高度（DH）、神经孔高度（NH）和节段性前凸。静态融合器可能需要过度试模和强力挤压，这可能导致终板破坏和下沉。可扩张融合器允许原位扩张，以帮助解决与静态融合器相关的并发症。
这是一项经机构审查委员会豁免的对69例诊断为DDD的患者（静态组，n = 32；可扩张组，n = 37）的回顾性研究，这些患者在1 - 2个连续节段接受了使用静态或可扩张融合器的MIS-LLIF。收集并比较术前和术后直至12个月的影像学和临床结果。
与静态组相比，可扩张组在6周、6个月和12个月时视觉模拟量表（VAS）评分的平均变化显著更高（12个月时的∆VAS：可扩张组，6.7±1.3；静态组，5.1±2.6）。可扩张组在3个月、6个月和12个月时Oswestry功能障碍指数（ODI）评分的平均改善明显优于静态组（12个月时的∆ODI：可扩张组，63.2±13.2；静态组，29.8±23.4）。两组在末次随访时平均DH和NH均显著增加，两组间DH改善无显著差异。与静态组相比，可扩张组在6周和6个月时NH的平均改善显著更大。在所有时间间隔内，可扩张组的节段性前凸相对于静态组均有显著改善。可扩张组在12个月时的下沉率显著低于静态组（1/46，2.2%）与静态组（12/37，32.4%）。
与静态融合器相比，可扩张融合器在12个月时导致显著更低的下沉率，改善了节段性前凸以及VAS和ODI结果。
