腰椎滑脱融合术后邻近节段退变的翻修手术：与 Roussouly 分型有关吗？
Revision Surgery for Adjacent Segment Degeneration After Fusion for Lumbar Spondylolisthesis: Is there a Correlation with Roussouly Type?
机构信息
Department of Neurological Surgery, University of California, San Francisco, CA.
Department of Orthopaedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China.
出版信息
Spine (Phila Pa 1976). 2022 Jan 1;47(1):E10-E15. doi: 10.1097/BRS.0000000000003708.
STUDY DESIGN
Retrospective study.
OBJECTIVE
The aim of this study was to investigate whether there is an association between revision surgery rates for adjacent segment degeneration (ASD) and Roussouly type after L4-5 transforaminal lumbar interbody fusion (TLIF) for spondylolisthesis.
SUMMARY OF BACKGROUND DATA
Revision surgery for ASD is known to occur after spinal fusion; however, it is unclear whether rates of ASD are associated with certain Roussouly types.
METHODS
Patients who underwent L4-5 TLIF for spondylolisthesis at the University of California San Francisco from January 2006 to December 2016 with minimum 2-year follow-up were retrospectively analyzed by Roussouly type. Revision surgery for ASD was noted and correlated by Roussouly type. Spinopelvic parameters were also measured for correlation. A value of P < 0.05 was significant.
RESULTS
There were 174 patients who met inclusion criteria, (59 males and 115 females). The average age was 62.3 (25-80) years. A total of 132 patients had grade I spondylolisthesis, and 42 had grade II. Mean follow-up was 45.2 months (24-497). A total of 22 patients (12.6%) underwent revision surgery for ASD after L4-5 TLIF. When classified by Roussouly type, revision surgery rates for ASD were: 1, 14.3%; 2, 22.6%; 3, 4.9%; and 4, 15.6% (P = 0.013). Type 3 spines with normal PI-LL (8.85° ± 6.83°) had the lowest revision surgery rate (4.9%), and type 2 spines with PI-LL mismatch (11.06° ± 8.81°) had the highest revision surgery rate (22.6%), a four-fold difference (P = 0.013). The PI-LL mismatch did not change significantly in each type postoperatively (P > 0.05).
CONCLUSION
We found that there may be a correlation between Roussouly type and revision surgery for ASD after L4-5 TLIF for spondylolisthesis, with type 2 spines having the highest rate. Spinopelvic parameters may also correlate with revision surgery for ASD after L4-5 TLIF.Level of Evidence: 4.
研究设计
回顾性研究。
目的
本研究旨在探讨 L4-5 经椎间孔腰椎体间融合术（TLIF）治疗腰椎滑脱症后，邻近节段退变（ASD）的翻修率与 Roussouly 分型之间是否存在关联。
背景资料概述
脊柱融合术后已知会发生 ASD 的翻修手术，但尚不清楚 ASD 发生率是否与某些 Roussouly 分型有关。
方法
通过 Roussouly 分型，对 2006 年 1 月至 2016 年 12 月在加利福尼亚大学旧金山分校接受 L4-5 TLIF 治疗腰椎滑脱症且随访时间至少 2 年的患者进行回顾性分析。记录并通过 Roussouly 分型对 ASD 的翻修手术进行相关性分析。还测量了脊柱骨盆参数以进行相关性分析。P 值<0.05 为有统计学意义。
结果
共有 174 名患者符合纳入标准，其中男性 59 名，女性 115 名。平均年龄为 62.3（25-80）岁。共有 132 例患者为Ⅰ度腰椎滑脱，42 例为Ⅱ度。平均随访时间为 45.2（24-497）个月。共有 22 例（12.6%）患者在 L4-5 TLIF 后因 ASD 行翻修手术。根据 Roussouly 分型，ASD 翻修手术率为：1 型为 14.3%；2 型为 22.6%；3 型为 4.9%；4 型为 15.6%（P=0.013）。PI-LL 正常（8.85°±6.83°）的 3 型脊柱具有最低的翻修手术率（4.9%），PI-LL 不匹配（11.06°±8.81°）的 2 型脊柱具有最高的翻修手术率（22.6%），相差四倍（P=0.013）。术后各型 PI-LL 不匹配无明显变化（P>0.05）。
结论
我们发现 L4-5 TLIF 治疗腰椎滑脱症后，Roussouly 分型与 ASD 翻修手术之间可能存在相关性，其中 2 型脊柱的发生率最高。脊柱骨盆参数也可能与 L4-5 TLIF 治疗腰椎滑脱症后 ASD 的翻修手术相关。
证据等级
4 级
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