Department of Orthopaedic Surgery, Boston Medical Center, Boston, MA.
Spine (Phila Pa 1976). 2021 Dec 15;46(24):1690-1695. doi: 10.1097/BRS.0000000000004115.
Retrospective case-control study.
The aim of this study was to evaluate the prevalence of pseudarthrosis following antepsoas (ATP) lumbar and lumbosacral fusions.
Pseudarthrosis is a feared complication following spinal fusions and may affect their clinical outcomes. To date there are no sufficient data on the fusion rate following ATP lumbar and lumbosacral arthrodesis.
This is a retrospective review of 220 patients who underwent lumbar minimally invasive antepsoas (MIS-ATP) fusions between January 2008 and February 2019 who have at least 1-year postoperative computed tomography (CT) follow-up scans. Fusion was graded using CT scans imaging and adopting a 1-4 grading scale (1, definitely fused; 2, likely fused; 3, likely not fused; 4, definitely not fused/nonunion). Grades 3 or 4 indicate pseudarthrosis.
A total of 220 patients (average age: 66 years, 82 males (37.2%), and 127 (57.7%) smokers) were included. Eight patients (3.6%) developed pseudarthrosis. A total of 693 discs were addressed using the ATP approach. Of those, 681 (98.3%) were considered fused (641 levels [92.5%] were "definitely fused" and 40 levels [5.8%] were "Likely fused") and 12 discs (1.7%) developed pseudarthrosis (seven levels [1.0%] were "likely not fused" and five levels (0.7%) were "definitely not fused"). The highest rate of pseudarthrosis was found at L5-S1 (4.8%) compared to the L1-L5 discs (0-2%). Of 127 smokers, six developed pseudarthrosis (odds ratio = 2.3, P = 0.3). The fusion rates were 95.3% and 97.8% for smokers and nonsmokers, respectively. Of the eight patients who developed pseudarthrosis, only four (50%) were symptomatic, of whom two (25%) required revision surgery. Both of these patients were smokers. The overall revision rate due to pseudarthrosis was 0.9% (two of 220 patients).
The MIS-ATP technique results in a high fusion rate (96.4% of patients; 98.3% of levels). Pseudarthrosis was noted mostly at the L5-S1 discs and in smokers.Level of Evidence: 4.
回顾性病例对照研究。
本研究旨在评估前路（ATP）腰椎和腰骶融合术后假关节形成的发生率。
假关节形成是脊柱融合术后一种可怕的并发症，可能影响其临床结果。迄今为止，尚无关于 ATP 腰椎和腰骶关节融合术后融合率的充分数据。
这是一项对 2008 年 1 月至 2019 年 2 月期间接受腰椎微创前路（MIS-ATP）融合术的 220 例患者的回顾性研究，这些患者至少有 1 年的术后计算机断层（CT）随访扫描。融合程度采用 CT 扫描图像，并采用 1-4 级评分（1，完全融合；2，可能融合；3，可能不融合；4，肯定不融合/假关节）进行分级。3 级或 4 级表示假关节形成。
共纳入 220 例患者（平均年龄：66 岁，82 例男性（37.2%），127 例（57.7%）吸烟者）。8 例（3.6%）发生假关节形成。共采用 ATP 方法处理 693 个椎间盘。其中，681 个（98.3%）被认为融合（641 个节段[92.5%]为“完全融合”，40 个节段[5.8%]为“可能融合”），12 个椎间盘（1.7%）发生假关节形成（7 个节段[1.0%]为“可能不融合”，5 个节段[0.7%]为“肯定不融合”）。假关节形成发生率最高的部位为 L5-S1（4.8%），而 L1-L5 椎间盘（0-2%）发生率较低。127 名吸烟者中，6 人发生假关节形成（比值比=2.3，P=0.3）。吸烟者的融合率为 95.3%，非吸烟者为 97.8%。发生假关节形成的 8 例患者中，仅有 4 例（50%）有症状，其中 2 例（25%）需要接受翻修手术。这两名患者均为吸烟者。因假关节形成而需要翻修的总发生率为 0.9%（220 例患者中有 2 例）。
MIS-ATP 技术可获得较高的融合率（96.4%的患者；98.3%的节段）。假关节形成主要发生在 L5-S1 椎间盘和吸烟者中。
4。
