Spine Surgery With Scoliosis Center, Schön Klinik Neustadt, Am Kiebitzberg 10, 23552, Neustadt in Holstein, Germany.
Eur Spine J. 2021 May;30(5):1277-1284. doi: 10.1007/s00586-020-06710-2. Epub 2021 Jan 6.
The mean potential of lordosis restoration by transforaminal lumbar interbody fusion (TLIF) is supposed to be low in general. In contrast, clinical experience shows a wide range of segmental lordosis correction. In this study, the predictability of lordosis correction should be investigated.
Prospectively collected register data were analyzed retrospectively. One hundred twenty-one consecutive patients (2014-2016) operated with single-level TLIF L4/5 (10°-lordotic cage). Segmental lordosis (L4/5) and overall lordosis (L1-S1) were measured on lumbar X-rays: preoperatively (pre), after 3-5 days (post), at least 24 months postoperatively (2yFU). Outcome and satisfaction of patients were assessed. Parameters were statistically compared by students t-tests (a = 0.05). In addition, predictors of correction were analyzed.
Age was 60.7 years, rate of 2yFU 41.3% (n = 50). Lordosis correction L4/5 was statistically significant with (post-pre) 4.9 ± 5.7° (p < 0.01), but not significant for L1-S1 (post-pre) 1.6 ± 8.0° (p = 0.3). A strong-moderate correlation of lordosis L4/5 (pre) and lordosis correction L4/5 (post-pre) was shown (r = - 0.6, p < 0,01). In a rising range of preoperative lordosis L4/5 from 15-30° the likelihood of lordosis loss increased. In 2yFU correction, L4/5 was significant with (post-pre) 5.4 ± 5.4° (p < 0.01), no significant long-term change (2yFU-postop) - 1.5 ± 4.9° (p = 0.2). No correlation (r = - 0.1) of correction and ODI. VAS-B improved by means of 2.9, VAS-L by 2.5, ODI by 19.1% (pre vs. 2yFU), each statistically significant (p < 0.01).
Significant segmental relordosation can be performed by TLIF L4/5. The potential of correction strongly correlates with preoperative lordosis. Therefore, TLIF technique should be considered carefully in cases with a preoperative segmental lordosis of more than 15° and additional need of lordosation.
经椎间孔腰椎体间融合术（TLIF）恢复腰椎前凸的平均潜力通常较低。相比之下，临床经验显示出广泛的节段性腰椎前凸矫正范围。在这项研究中，应研究腰椎前凸矫正的可预测性。
回顾性分析前瞻性收集的登记数据。121 例连续患者（2014-2016 年）行单节段 TLIF L4/5（10°-前凸椎间融合器）。腰椎 X 线片测量节段性腰椎前凸（L4/5）和整体腰椎前凸（L1-S1）：术前（pre）、术后 3-5 天（post）、至少 24 个月随访时（2yFU）。评估患者的结果和满意度。通过学生 t 检验（a = 0.05）对参数进行统计学比较。此外，还分析了矫正的预测因素。
患者年龄为 60.7 岁，2yFU 率为 41.3%（n = 50）。L4/5 节段性腰椎前凸矫正具有统计学意义（post-pre）为 4.9 ± 5.7°（p < 0.01），但 L1-S1 无统计学意义（post-pre）为 1.6 ± 8.0°（p = 0.3）。显示 L4/5 腰椎前凸（pre）和 L4/5 腰椎前凸矫正（post-pre）之间存在强-中度相关性（r = - 0.6，p < 0.01）。在术前 L4/5 腰椎前凸从 15-30°的升高范围内，腰椎前凸丢失的可能性增加。在 2yFU 矫正中，（post-pre）为 5.4 ± 5.4°，具有统计学意义（p < 0.01），无长期显著变化（2yFU-postop）为-1.5 ± 4.9°（p = 0.2）。校正与 ODI 之间无相关性（r = - 0.1）。VAS-B 改善 2.9，VAS-L 改善 2.5，ODI 改善 19.1%（pre 与 2yFU），均具有统计学意义（p < 0.01）。
TLIF L4/5 可显著进行节段性腰椎前凸再复位。矫正的潜力与术前腰椎前凸密切相关。因此，对于术前节段性腰椎前凸超过 15°且需要进一步腰椎前凸的患者，应慎重考虑 TLIF 技术。
