Department of Orthopaedic Surgery, National Hospital Organization, Murayama Medical Center, Musashimurayama, Tokyo, Japan.
Department of Orthopaedic Surgery, National Hospital Organization, Murayama Medical Center, Musashimurayama, Tokyo, Japan.
J Orthop Sci. 2022 Nov;27(6):1203-1207. doi: 10.1016/j.jos.2021.07.026. Epub 2021 Sep 14.
The bicortical or tricortical fixation technique with purchase into the anterior sacral wall or promontory has been recommended to achieve rigid sacral pedicle screw fixation, which carries the potential risk of neurovascular injuries. The penetrating endplate screw (PES) technique was proposed as an alternative screw trajectory to facilitate both strong fixation and safety. However, there has been no report on the practical significance of using the PES technique. The aim of the present study was to investigate radiological outcomes using the PES technique for lumbosacral fusion by comparing it with the anterior bicortical technique.
The subjects consisted of 44 patients with L5 isthmic spondylolisthesis who underwent single-level posterior lumbar interbody fusion at L5-S using the PES technique (20 patients) or the anterior bicortical technique (24 patients) and were followed up for > 2 years (mean follow-up: 36.6 months). Screw loosening and bone fusion were radiologically assessed and compared between the two groups. Factors contributing to bone fusion were investigated using the following factors: (1) age, (2) sex, (3) body mass index, (4) bone mineral density, (5) screw diameter, (6) screw length, (7) pelvic incidence, (8) crosslink connector, (9) cage material, and (10) sacral screw insertion technique.
Respective screw loosening and bone fusion rates were 10.0 and 90.0% using the PES technique and 29.2 and 79.2% using the anterior bicortical technique, with no significant differences between the two techniques. Multivariate logistic regression analysis revealed that the age (odds ratio = 0.87, p = 0.02) and PES technique (odds ratio = 22.39, p = 0.02) were significant independent factors contributing to bone fusion.
This is the first study to demonstrate the significance of using the PES technique to improve radiological outcomes. The PES technique could be a valid option for lumbosacral fixation for L5 isthmic spondylolisthesis in terms of improved bone fusion.
双皮质或三皮质固定技术通过进入前骶骨壁或岬部进行固定，以实现刚性骶骨椎弓根螺钉固定，但存在潜在的神经血管损伤风险。穿透终板螺钉（PES）技术被提出作为替代螺钉轨迹，以促进牢固固定和安全性。然而，目前尚无关于使用 PES 技术的实际意义的报告。本研究旨在通过与前路双皮质技术比较，研究使用 PES 技术进行腰骶融合的影像学结果。
本研究共纳入 44 例 L5 峡部裂性脊椎滑脱患者，均采用 PES 技术（20 例）或前路双皮质技术（24 例）进行单节段后路腰椎间融合术，随访时间>2 年（平均随访时间：36.6 个月）。比较两组患者螺钉松动和骨融合情况。采用以下因素对骨融合的影响因素进行分析：（1）年龄，（2）性别，（3）体重指数，（4）骨密度，（5）螺钉直径，（6）螺钉长度，（7）骨盆入射角，（8）交叉连接器，（9）椎间融合器材料，（10）骶骨螺钉置入技术。
PES 技术的螺钉松动和骨融合率分别为 10.0%和 90.0%，前路双皮质技术分别为 29.2%和 79.2%，两组间无统计学差异。多因素逻辑回归分析显示，年龄（比值比=0.87，p=0.02）和 PES 技术（比值比=22.39，p=0.02）是影响骨融合的独立因素。
这是第一项证明使用 PES 技术改善影像学结果的意义的研究。在治疗 L5 峡部裂性脊椎滑脱方面，PES 技术可能是一种有效的腰骶固定方法，可提高骨融合率。
