Guppy Kern H, Royse Kathryn E, Norheim Elizabeth P, Moller David J, Suen Patrick W, Rahman Shayan U, Harris Jessica E, Brara Harsimran S
The Permanente Medical Group, Sacramento, California, USA.
Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, California, USA.
World Neurosurg. 2021 Jan;145:e131-e140. doi: 10.1016/j.wneu.2020.09.142. Epub 2020 Oct 1.
Radiographic nonunion rates in the literature for posterolateral lumbar fusions with pedicle screws (PLFs) range from 8.1% to 43.3% but may not represent nonunion rates. A few small studies have reported reoperations for symptomatic nonunions (operative nonunions) to range from 3.2% to 13.9%. The objective of this study is to determine operative nonunion rates for 1-level, 2-level, 3-level, and ≥4-level PLFs and to determine the risks for these nonunions.
A retrospective cohort study, using data from the Kaiser Permanente Spine Registry, identified adult patients (≥18 years old) who underwent PLFs for degenerative disc disease. Multivariable Cox proportional hazards regression and Kaplan-Meier survival estimates using the log-rank statistic were used to evaluate operative nonunion rates.
The cohort consisted of 2591 patients with single-level and multilevel PLFs with mean follow-up of 4.6 years, time to operative nonunion of 1.52 years, and 2-year operative nonunion rate of 1.08%. Compared with single-level fusions, patients with 3-level and ≥4-level fusion had 2.8 and 3.7 times higher risk of operative nonunions. Patients with PLFs involving L5-S1 had 2.5 times the risk of an operative nonunion compared with those without.
Our study reports results from one of the largest cohort of patients for the first time with single-level and multilevel instrumented PLFs and found a 2-year operative nonunion rate of 1.08% with increased risk of nonunion for constructs that included L5-S1 and ≥3-level fusions. Operative nonunion combines clinical and radiographic data and provides an alternative measure of fusion rates.
文献中关于使用椎弓根螺钉的腰椎后外侧融合术（PLF）的影像学骨不连发生率在8.1%至43.3%之间，但可能并不代表实际骨不连发生率。一些小型研究报告称，有症状性骨不连（手术相关骨不连）的再次手术率在3.2%至13.9%之间。本研究的目的是确定单节段、双节段、三节段和≥四节段PLF的手术相关骨不连发生率，并确定这些骨不连的风险因素。
一项回顾性队列研究，使用凯撒永久医疗脊柱登记处的数据，纳入因退行性椎间盘疾病接受PLF的成年患者（≥18岁）。采用多变量Cox比例风险回归和使用对数秩统计量的Kaplan-Meier生存估计来评估手术相关骨不连发生率。
该队列包括2591名单节段和多节段PLF患者，平均随访4.6年，手术相关骨不连的时间为1.52年，2年手术相关骨不连发生率为1.08%。与单节段融合相比，三节段和≥四节段融合患者发生手术相关骨不连的风险分别高2.8倍和3.7倍。涉及L5-S1的PLF患者发生手术相关骨不连的风险是未涉及者的2.5倍。
我们的研究首次报告了单节段和多节段器械辅助PLF患者的最大队列之一的结果，发现2年手术相关骨不连发生率为1.08%，对于包括L5-S1和≥三节段融合的结构，骨不连风险增加。手术相关骨不连结合了临床和影像学数据，提供了一种融合率的替代测量方法。
