Derman Peter B, Singh Kern
Texas Back Institute, Plano, TX USA.
Department of Orthopedic Surgery, Rush University Medical Center, 1611 W. Harrison St., Suite #300, Chicago, IL 60612 USA.
HSS J. 2020 Jul;16(2):183-187. doi: 10.1007/s11420-019-09732-9. Epub 2019 Oct 30.
Pseudarthrosis after lumbar fusion can generate pain and disability and often requires revision. However, results of revision procedures have historically been relatively poor.
QUESTIONS/PURPOSE: The aim of this review was to examine the current evidence related to the management of lumbar pseudarthrosis, with a focus on revision after failure of posterolateral fusion or lumbar interbody fusion.
A review of orthopedic spine literature published before March 2019 was conducted using PubMed and Google Scholar. Studies addressing revision after failed posterolateral fusions and after failed interbody fusion were selected. We also present a case of successful revision after failed transforaminal lumbar interbody fusion (TLIF).
The review revealed that persistent pseudarthrosis after revision posterolateral fusion occurs at rates of 35 to 51%. No significant difference has been demonstrated in rates of successful fusion after anterior lumbar interbody fusion (ALIF) and ALIF with revision posterolateral fusion for pseudarthroses after failed TLIF procedures (81% versus 88%), although ALIF alone may be appealing because it avoids further disruption of the posterior musculature. No significant differences have been observed in quality-of-life scores among patients undergoing revision after posterolateral fusion, TLIF, ALIF, or ALIF with posterior fusion. Failed TLIF cages may be extracted and replaced through an anterior or lateral approach. If the geometry of the failed cage permits insertion of a second cage, a contralateral approach may be used. Revision retroperitoneal approaches are associated with higher complication rates.
The management of lumbar pseudarthrosis requires careful planning, as well as intra-operative attention to detail, for revision surgery to be successful. Circumferential procedures have shown success in revision posterolateral and interbody fusion failures.
腰椎融合术后假关节形成可导致疼痛和功能障碍，通常需要翻修手术。然而，以往翻修手术的效果相对较差。
问题/目的：本综述旨在研究与腰椎假关节处理相关的现有证据，重点关注后外侧融合或腰椎椎间融合失败后的翻修手术。
使用PubMed和谷歌学术对2019年3月之前发表的骨科脊柱文献进行综述。选取了关于后外侧融合失败和椎间融合失败后翻修的研究。我们还展示了1例经椎间孔腰椎椎间融合术（TLIF）失败后成功翻修的病例。
综述显示，后外侧融合翻修术后持续性假关节形成的发生率为35%至51%。对于TLIF手术失败后假关节形成，单纯前路腰椎椎间融合术（ALIF）与ALIF联合后外侧融合翻修术的成功融合率无显著差异（81%对88%），不过单纯ALIF可能更具吸引力，因为它避免了进一步破坏后方肌肉组织。在后外侧融合、TLIF、ALIF或ALIF联合后外侧融合翻修术后的患者中，生活质量评分未见显著差异。失败的TLIF椎间融合器可通过前路或侧路取出并更换。如果失败椎间融合器的几何形状允许插入第二个椎间融合器，则可采用对侧入路。腹膜后翻修入路的并发症发生率较高。
腰椎假关节的处理需要仔细规划以及术中对细节的关注，以使翻修手术成功。环形手术已显示出在后外侧融合和椎间融合失败翻修中的成功。
