Verma Ravi, Virk Sohrab, Qureshi Sheeraz
Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E. 70th St., New York, NY 10021 USA.
HSS J. 2020 Jul;16(2):162-167. doi: 10.1007/s11420-019-09737-4. Epub 2020 Jan 13.
Lumbar interbody fusion is among the most common types of spinal surgery performed. Over time, the term has evolved to encompass a number of different approaches to the intervertebral space, as well as differing implant materials. Questions remain over which approaches and materials are best for achieving fusion and restoring disc height.
QUESTIONS/PURPOSES: We reviewed the literature on the advantages and disadvantages of various methods and devices used to achieve and augment fusion between the disc spaces in the lumbar spine.
Using search terms specific to lumbar interbody fusion, we searched PubMed and Google Scholar and identified 4993 articles. We excluded those that did not report clinical outcomes, involved cervical interbody devices, were animal studies, or were not in English. After exclusions, 68 articles were included for review.
Posterior approaches have advantages, such as providing 360° support through a single incision, but can result in retraction injury and do not always restore lordosis or correct deformity. Anterior approaches allow for the largest implants and good correction of deformities but can result in vascular, urinary, psoas muscle, or lumbar plexus injury and may require a second posterior procedure to supplement fixation. Titanium cages produce improved osteointegration and fusion rates but also increase subsidence caused by the stiffness of titanium relative to bone. Polyetheretherketone (PEEK) has an elasticity closer to that of bone and shows less subsidence than titanium cages, but as an inert compound PEEK results in lower fusion rates and greater osteolysis. Combination PEEK-titanium coating has not yet achieved better results. Expandable cages were developed to increase disc height and restore lumbar lordosis, but the data on their effectiveness have been inconclusive. Three-dimensionally (3D)-printed cages have shown promise in biomechanical and animal studies at increasing fusion rates and reducing subsidence, but additive manufacturing options are still in their infancy and require more investigation.
All of the approaches to spinal fusion have plusses and minuses that must be considered when determining which to use, and newer-technology implants, such as PEEK with titanium coating, expandable, and 3D-printed cages, have tried to improve upon the limitations of existing grafts but require further study.
腰椎椎间融合术是最常见的脊柱手术类型之一。随着时间的推移，该术语已发展为涵盖多种不同的进入椎间隙的方法以及不同的植入材料。关于哪种方法和材料最适合实现融合和恢复椎间盘高度，仍然存在疑问。
问题/目的：我们回顾了有关用于实现和增强腰椎椎间隙融合的各种方法和装置的优缺点的文献。
使用特定于腰椎椎间融合术的搜索词，我们在PubMed和谷歌学术上进行了搜索，共识别出4993篇文章。我们排除了那些未报告临床结果、涉及颈椎椎间装置、属于动物研究或非英文的文章。排除后，纳入68篇文章进行综述。
后路手术具有优点，例如通过单一切口提供360°支撑，但可能导致牵拉损伤，并且并不总是能恢复前凸或纠正畸形。前路手术允许使用最大的植入物并能很好地矫正畸形，但可能导致血管、泌尿系统、腰大肌或腰丛损伤，并且可能需要第二次后路手术来补充固定。钛笼可提高骨整合和融合率，但由于钛相对于骨的刚度，也会增加下沉。聚醚醚酮（PEEK）的弹性更接近骨，并且比钛笼显示出更少的下沉，但作为一种惰性化合物，PEEK会导致较低的融合率和更大的骨溶解。PEEK-钛涂层组合尚未取得更好的效果。可扩张笼是为增加椎间盘高度和恢复腰椎前凸而开发的，但其有效性的数据尚无定论。三维（3D）打印笼在生物力学和动物研究中显示出提高融合率和减少下沉的前景，但增材制造选项仍处于起步阶段，需要更多研究。
所有脊柱融合方法都有其优缺点，在决定使用哪种方法时必须加以考虑，并且诸如带有钛涂层的PEEK、可扩张和3D打印笼等新技术植入物试图改善现有移植物的局限性，但需要进一步研究。
