Himchan and UHS Spine and Joint Centre, University Hospital Sharjah, Sharjah, United Arab Emirates.
Department of Pharmaceutical Medicine and Regulatory Sciences, College of Medicine and Pharmacy, Yonsei University, Seoul, Republic of South Korea.
J Orthop Surg Res. 2020 Sep 29;15(1):442. doi: 10.1186/s13018-020-01866-5.
Lumbar lordosis (LL) can be restored, and screw-related complications may be avoided with the stand-alone expandable cage method. However, the long-term spinopelvic changes and safety remain unknown. We aimed to elucidate the long-term radiologic outcomes and safety of this technique.
Data from patients who underwent multi-level stand-alone expandable cage fusion and 80 patients who underwent screw-assisted fusion between February 2007 and December 2012, with at least 5 years of follow-up, were retrospectively analyzed. Segmental angle and translation, short and whole LL, pelvic incidence, pelvic tilt, sacral slope (SS), sagittal vertical axis, thoracic kyphosis, and presence of subsidence, pseudoarthrosis, retropulsion, cage breakage, proximal junctional kyphosis (PJK), and screw malposition were assessed. The relationship between local, lumbar, and spinopelvic effects was investigated. The implant failure rate was considered a measure of procedure effectiveness and safety.
In total, 69 cases were included in the stand-alone expandable cage group and 150 cases in the control group. The stand-alone group showed shorter operative time (58.48 ± 11.10 vs 81.43 ± 13.75, P = .00028), lower rate of PJK (10.1% vs 22.5%, P = .03), and restoration of local angle (4.66 ± 3.76 vs 2.03 ± 1.16, P = .000079) than the control group. However, sagittal balance (0.01 ± 2.57 vs 0.50 ± 2.10, P = .07) was not restored, and weakness showed higher rate of subsidence (16.31% vs 4.85%, P = .0018), pseudoarthrosis (9.92% vs 2.42%, P = .02), cage, and retropulsion (3.55% vs 0, P = .01) than the control group.
Stand-alone expandable cage fusion can restore local lordosis; however, global sagittal balance was not restored. Furthermore, implant safety has not yet been proven.
腰椎前凸（LL）可以通过独立的可扩张 cage 方法来恢复，并且可以避免与螺钉相关的并发症。然而，长期的脊柱骨盆变化和安全性仍不清楚。我们旨在阐明该技术的长期影像学结果和安全性。
回顾性分析了 2007 年 2 月至 2012 年 12 月期间接受多节段独立可扩张 cage 融合的患者和 80 例接受螺钉辅助融合的患者的数据，这些患者至少随访了 5 年。评估了节段角度和移位、短节段和全长 LL、骨盆入射角、骨盆倾斜角、骶骨倾斜角（SS）、矢状垂直轴、胸椎后凸角以及塌陷、假关节、后凸、 cage 破裂、近端交界性后凸（PJK）和螺钉位置不当的发生情况。研究了局部、腰椎和脊柱骨盆效应之间的关系。将植入物失败率视为手术效果和安全性的衡量标准。
共纳入 69 例独立可扩张 cage 组和 150 例对照组。独立组的手术时间更短（58.48 ± 11.10 对 81.43 ± 13.75，P =.00028）、PJK 发生率更低（10.1%对 22.5%，P =.03），以及局部角度的恢复（4.66 ± 3.76 对 2.03 ± 1.16，P =.000079）均优于对照组。然而，矢状平衡（0.01 ± 2.57 对 0.50 ± 2.10，P =.07）没有得到恢复，并且存在较高的塌陷率（16.31%对 4.85%，P =.0018）、假关节（9.92%对 2.42%，P =.02）、cage 和后凸（3.55%对 0，P =.01）的风险。
独立的可扩张 cage 融合可以恢复局部前凸；然而，整体矢状平衡没有得到恢复。此外，植入物的安全性尚未得到证实。
