Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Istituto di Ortopedia e Traumatologia, Università Cattolica del Sacro Cuore, Rome, Italy.
Radiol Med. 2021 Feb;126(2):250-257. doi: 10.1007/s11547-020-01252-5. Epub 2020 Jul 11.
There is no consensus on how to evaluate segmental fusion after lateral lumbar interbody fusion (LLIF). Bone bridges (BB) between two contiguous vertebra are reported as pathognomonic criteria for anterior fusion. However, to the best of our knowledge, there are no radiological investigations on zygapophyseal joints (ZJ) status after LLIF. The aim of this radiological study was to investigate the different fusion patterns after LLIF.
This is a retrospective single-centre radiological study. Patients who underwent LLIF and posterior percutaneous screw fixation for degenerative spondylolisthesis, on a single lumbar level, were considered for eligibility. Complete radiological data and a minimum follow-up of 1 year were the inclusion criteria. Intervertebral BB were investigated for evaluating anterior fusion and ZJ ankylotic degeneration was evaluated according Pathria et al., as a matter of proof of posterior fusion and segmental immobilization.
Seventy-four patients were finally included in the present study. Twelve months after surgery, intervertebral BB were recognized in 58 segments (78.3%), whereas ZJ Pathria grade was I in 8 (10.8%) patients, II in 15 (20.3%) and III in 51 (68.9%) that were considered posteriorly fused. The overlapping rate between anteriorly and posteriorly fused segments was 72.4% (42 segments), whereas 10 (13.5%) did not achieve any fusion, anterior or posterior, and 6 (8.1%) were posteriorly fused only.
Our results seem to suggest that anterior fusion is not sufficient to achieve segmental immobilization. Further properly designed investigations are needed to investigate eventual clinical-radiological correlations.
目前对于侧方腰椎间融合术（LLIF）后节段融合的评估尚无共识。在两个连续的椎骨之间形成的骨桥（BB）被报道为前融合的特征性标准。然而，据我们所知，目前还没有关于 LLIF 后小关节（ZJ）状态的影像学研究。本研究旨在通过影像学方法研究 LLIF 后不同的融合模式。
这是一项回顾性的单中心影像学研究。符合纳入标准的患者为：接受 LLIF 及后路经皮螺钉固定治疗单节段退行性腰椎滑脱的患者。纳入标准为：具有完整的影像学资料和至少 1 年的随访。我们通过观察椎间隙骨桥（BB）来评估前融合，根据 Pathria 等人的标准评估 ZJ 关节强直来证明后融合和节段固定。
最终纳入 74 例患者。术后 12 个月，58 个节段（78.3%）可见椎间隙骨桥（BB），而 ZJPathria 分级为 I 级的患者有 8 例（10.8%），II 级的患者有 15 例（20.3%），III 级的患者有 51 例（68.9%），被认为是后路融合。前路和后路融合节段的重叠率为 72.4%（42 个节段），10 个节段（13.5%）未发生任何融合，无论是前路还是后路，6 个节段（8.1%）仅为后路融合。
我们的研究结果似乎表明，前路融合不足以实现节段固定。需要进一步进行适当设计的研究来调查潜在的临床影像学相关性。
