腰椎后路器械融合术中使用聚醚醚酮（PEEK）棒会降低相邻节段疾病的风险吗？
Do PEEK Rods for Posterior Instrumented Fusion in the Lumbar Spine Reduce the Risk of Adjacent Segment Disease?
作者信息
Hirt Daniel, Prentice Heather A, Harris Jessica E, Paxton Elizabeth W, Alexander Jessa, Nagasawa Daniel T, Khosla Deven, Kurtz Steven M
机构信息
Department of Neurosurgery, Southern California Permanente Medical Group, Los Angeles, California.
Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, California.
出版信息
Int J Spine Surg. 2021 Apr;15(2):251-258. doi: 10.14444/8034.
BACKGROUND
Polyetheretherketone (PEEK) rods were clinically introduced in the mid-2000s as an alternative to titanium (Ti) rods for posterior instrumented lumbar spine fusion, theorized to reduce the risk of adjacent segment disease (ASD). However, few studies have follow-up beyond 2 years. Consequently, we conducted a matched cohort study using data from Kaiser Permanente's spine registry to compare the 2 rod systems and risk for outcomes.
METHODS
Patients aged ≥18 undergoing first posterior lumbar fusion for a degenerative diagnosis from 2009 to 2018 using either a PEEK or a Ti rod were identified. Fusions using Ti rods were 2:1 propensity score matched to PEEK rods on the following factors: patient age, body mass index, smoking, American Society of Anesthesiologists classification, diagnosis, interbody use, bone morphogenic protein use, number of levels fused, fusion levels, and operative year. The matched sample included 154 PEEK and 308 Ti fusions. We used Cox regression to evaluate ASD and nonunion, and logistic regression to evaluate 90-day emergency department (ED) visit, readmission, and complication.
RESULTS
We did not observe a difference in risk for ASD (hazard ratio = 1.02, 95% confidence interval [CI] = 0.66-1.59) or ED visit (odds ratio [OR] = 0.88, 95% CI = 0.48-1.59). A lower likelihood of readmission (OR = 0.34, 95% CI = 0.13-0.94) was observed following PEEK fusion compared with Ti. No nonunions or 90-day complications were observed for the PEEK group; 5 (2-year cumulative incidence = 0.7%) nonunions and 4 (1.3%) complications were observed for the Ti group.
CONCLUSIONS
Our multicenter study did not support the hypothesis that PEEK rods are associated with a lower ASD risk. Reasons for readmission need to be identified to better understand the differences observed here. Further study of patients with TLIF using Ti and PEEK rods and posterolateral fusion with Ti and PEEK rods is needed.
CLINICAL RELEVANCE
The present study adds to the literature supporting their midterm effectiveness of PEEK rods compared with Ti rods for both their safety and their effectiveness at the 5-7-year follow-up.
LEVEL OF EVIDENCE
背景
聚醚醚酮（PEEK）棒在21世纪中叶开始临床应用，作为钛（Ti）棒用于腰椎后路器械融合术的替代品，理论上可降低相邻节段疾病（ASD）的风险。然而，很少有研究随访超过2年。因此，我们利用凯撒医疗集团脊柱登记处的数据进行了一项匹配队列研究，以比较这两种棒系统及其预后风险。
方法
确定2009年至2018年期间年龄≥18岁、因退行性疾病首次接受腰椎后路融合术且使用PEEK或Ti棒的患者。使用Ti棒的融合术在以下因素上按倾向评分2:1与PEEK棒匹配：患者年龄、体重指数、吸烟情况、美国麻醉医师协会分级、诊断、椎间融合器使用情况、骨形态发生蛋白使用情况、融合节段数、融合节段以及手术年份。匹配样本包括154例PEEK融合术和308例Ti融合术。我们使用Cox回归评估ASD和骨不连，并使用逻辑回归评估90天内急诊科就诊、再入院和并发症情况。
结果
我们未观察到ASD风险（风险比=1.02，95%置信区间[CI]=0.66 - 1.59）或急诊科就诊风险（比值比[OR]=0.88，95% CI=0.48 - 1.59）存在差异。与Ti融合术相比，PEEK融合术后再入院的可能性较低（OR=0.34，95% CI=0.13 - 0.94）。PEEK组未观察到骨不连或90天内并发症；Ti组观察到5例骨不连（2年累积发生率=0.7%）和4例并发症（1.3%）。
结论
我们的多中心研究不支持PEEK棒与较低ASD风险相关的假设。需要确定再入院的原因，以更好地理解此处观察到的差异。需要对使用Ti和PEEK棒进行经椎间孔腰椎椎间融合术（TLIF）的患者以及使用Ti和PEEK棒进行后外侧融合术的患者进行进一步研究。
临床意义
本研究补充了文献，支持了PEEK棒与Ti棒在5至7年随访期的安全性和有效性方面的中期效果。
证据级别
3级。
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