Zhang Hanci, Dial Brian, Brown Christopher
Department of Orthopaedic Surgery, Duke University Medical Center; Durham, North Carolina.
Int J Spine Surg. 2021 Jun;15(3):423-428. doi: 10.14444/8063. Epub 2021 May 7.
Direct lateral (transpsoas) lumbar interbody fusion (LLIF) reportedly achieves union by 1 year postoperatively, but how soon fusion occurs after these minimally invasive procedures is unclear. This study investigated LLIF fusion progression at 6 months and 1 year in a large-scale cohort using bone morphogenetic protein (BMP) graft and examined risk factors associated with failed fusion.
Patients undergoing primary LLIF with a single surgical team from 2015 through 2016 with polyetheretherketone (PEEK) iimplants and BMP graft were identified. Retrospective chart review included demographics and medical history, construct length and location, and concurrent L5-S1 fusion. Inclusion criteria included minimum 1-year follow-up and postoperative lumbar computed tomography at 6 months and 1 year, which was independently assessed for bony union at each level.
166 patients underwent LLIF at a total of 312 levels. Seventy-nine patients (48%) underwent 1-level fusion; 45 (27%), 2 levels; and 42 (25%), 3 or more levels. At 6 months, 160 (51%) levels showed fusion. At 1 year, 70% of the remainder were fused, and total fusion rate was 85%. Fusion rates from L1 through L4 were similar (84%-87%). Nonunion was not significantly associated with construct length ( .19), concurrent anterior L5-S1 interbody fusion ( .50), age ( .70), BMI ( .15), or comorbidities such as diabetes ( .86) or thyroid disease ( .46).
This large retrospective cohort study corroborates prior 1-year LLIF fusion rate reports (85%) independent of construct length or location or medical comorbidities. Significantly, half showed fusion by 6 months, earlier than previously described and validating the efficacy of LLIF.
This study presents a large cohort of patients to support effective lumbar fusion after LLIF with BMP-2.
据报道，直接外侧（经腰大肌）腰椎椎间融合术（LLIF）在术后1年实现融合，但在这些微创手术后融合多快发生尚不清楚。本研究在一个使用骨形态发生蛋白（BMP）移植物的大规模队列中调查了6个月和1年时的LLIF融合进展情况，并检查了与融合失败相关的危险因素。
确定2015年至2016年由单一手术团队进行初次LLIF且使用聚醚醚酮（PEEK）植入物和BMP移植物的患者。回顾性病历审查包括人口统计学和病史、植入物长度和位置以及同期L5 - S1融合情况。纳入标准包括至少1年的随访以及6个月和1年时的术后腰椎计算机断层扫描，对每个节段的骨融合情况进行独立评估。
166例患者共进行了312个节段的LLIF。79例患者（48%）进行了1节段融合；45例（27%）进行了2节段融合；42例（25%）进行了3个或更多节段融合。在6个月时，160个（51%）节段显示融合。在1年时，其余节段中有70%实现融合，总融合率为85%。L1至L4节段的融合率相似（84% - 87%）。不融合与植入物长度（P = 0.19）、同期L5 - S1前路椎间融合（P = 0.50）、年龄（P = 0.70）、体重指数（P = 0.15）或合并症如糖尿病（P = 0.86）或甲状腺疾病（P = 0.46）均无显著相关性。
这项大型回顾性队列研究证实了先前的1年LLIF融合率报告（85%），且与植入物长度、位置或内科合并症无关。重要的是，半数患者在6个月时显示融合，比先前描述的时间更早，验证了LLIF的疗效。
5级。
本研究展示了一大队列患者，以支持使用BMP - 2的LLIF术后有效的腰椎融合。
