Martin Christopher T, Niu Shuo, Whicker Emily, Ward Laura, Yoon S Tim
Emory University, Department of Orthopaedics, Atlanta, Georgia.
University of Minnesota, Department of Orthopaedics, Minneapolis, Minnesota.
Int J Spine Surg. 2020 Oct;14(5):681-686. doi: 10.14444/7099. Epub 2020 Oct 23.
The study design was a retrospective cohort study. The objective was to identify preoperative (preop) radiographic features that are associated with increased lordosis correction after transforaminal lumbar interbody fusion (TLIF).
We retrospectively reviewed a single surgeon series of TLIF performed at L4-5 since 2010. The surgical technique involved unilateral facetectomy and insertion of a banana-type cage. A total of 107 cases were available with plain radiographs, and 62 with a preop computed tomography (CT) scan. We compared segmental lordosis correction between the preop and 6-week postoperative radiographs. Patients were divided into groups of those with or without more than 5° lordosis correction. Radiographic features were then compared, and a multivariate analysis was performed.
The mean lordosis correction of the entire cohort was 2.5° (range = -9° to 16°). The percentage of patients with a vacuum disc on the preop CT (40% vs 10%, = 0.01) was higher in the group with greater than 5° lordosis correction, whereas the mean preop segmental lordosis (14.3° vs 18.6°) and the preop segmental disc angle (6.4° vs 8.4°) were both lower ( < 0.05 for each). The percentage of patients with a Meyerding grade of 2 or higher (28% vs 16%) trended higher but was not significant ( = 0.1). There was no significant difference in the mean body mass index, patient age, preop lumbar lordosis, or disc space height.
Patients with a preop vacuum disc sign on CT scan or those with a more kyphotic disc space on preop radiographs were more likely to achieve lordosis correction. This information may be useful in preop planning.
Unilateral TLIF is likely to be neutral or kyphogenic in patients with a segmental disc angle that is neutral or lordotic pre-operatively, but is likely to increase segmental lordosis in patients with a disc angle that is kyphotic pre-oepratively.
本研究设计为回顾性队列研究。目的是确定经椎间孔腰椎椎间融合术（TLIF）后与腰椎前凸矫正增加相关的术前影像学特征。
我们回顾性分析了自2010年以来同一外科医生所做的L4 - 5节段TLIF手术系列。手术技术包括单侧小关节切除术和植入香蕉型椎间融合器。共有107例患者有平片，62例有术前计算机断层扫描（CT）。我们比较了术前和术后6周X线片上的节段性腰椎前凸矫正情况。患者被分为腰椎前凸矫正超过5°和未超过5°的两组。然后比较影像学特征，并进行多因素分析。
整个队列的平均腰椎前凸矫正为2.5°（范围 = -9°至16°）。腰椎前凸矫正超过5°的组中，术前CT显示椎间盘真空征的患者百分比更高（40%对10%，P = 0.01），而术前平均节段性腰椎前凸（14.3°对18.6°）和术前节段性椎间盘角度（6.4°对8.4°）均更低（每项P < 0.05）。Meyerding分级为2级或更高的患者百分比（28%对16%）有升高趋势但无统计学意义（P = 0.1）。平均体重指数、患者年龄、术前腰椎前凸或椎间盘间隙高度无显著差异。
术前CT扫描有椎间盘真空征或术前X线片显示椎间盘间隙后凸更明显的患者更有可能实现腰椎前凸矫正。该信息可能对术前规划有用。
4级。
对于术前节段性椎间盘角度为中立位或前凸的患者，单侧TLIF可能为中立位或致后凸，但对于术前椎间盘角度为后凸的患者，单侧TLIF可能会增加节段性腰椎前凸。
