Mathew Justin, Cerpa Meghan, Lee Nathan J, Boddapati Venkat, Marciano Gerard, Sardar Zeeshan M, Lenke Lawrence G
Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA.
J Spine Surg. 2021 Sep;7(3):318-325. doi: 10.21037/jss-21-15.
Few studies directly compare the effect of interbody cages with different degrees of lordosis in producing segmental lumbar lordosis (SLL) in the transforaminal lumbar interbody fusion (TLIF) procedure. Thus, we aimed to investigate changes in SLL in hyperlordotic cages compared to standard lordotic cages in open TLIF procedures.
Thirty-eight consecutive patients who received open TLIF procedures performed by a single surgeon between 2017 and 2018 were reviewed. Twenty patients had "hyperlordotic cages" (20° lordosis), while 18 patients had "standard lordotic cages" (6° lordosis). Twenty-three patients had one-level TLIF procedures and 15 had two-level TLIF. Standard radiographic measurements, including SLL were assessed preoperatively, postoperatively, and at 1-year follow-up. SLL was measured from the superior endplate of the cephalad vertebra to the inferior endplate of the caudal vertebra. Changes in SLL were compared using Student's and paired t-tests.
In one- and two-level open TLIF, both hyperlordotic and standard lordotic cages produced significant improvement in SLL. Among those receiving a one-level TLIF, SLL increased 7.8° (P=0.024) in those with standard lordotic cages; it increased 8.2° (P=0.020) in those with hyperlordotic cages. Among those receiving a two-level TLIF, SLL increased 13.9° (P=0.032) in those with standard lordotic cages; it increased 8.8° (P=0.023) in those with hyperlordotic cages. However, the improvement in SLL was not significantly different between the two cage types in either one or two-level TLIF procedures (P=0.917, P=0.389). At 1-year follow-up, there was no significant change in SLL, among standard lordotic and hyperlordotic cages (P=0.501, P=0.781).
Although it is theorized that hyperlordotic cages would increase SLL during open TLIF procedures more than standard lordotic cages, our data failed to demonstrate that. As our study examined cases performed by a single surgeon immediately before and after adoption of these lordotic cages, it is likely that surgical technique is of equal or greater importance in improving SLL than the amount of lordosis designed into interbody cages.
很少有研究直接比较不同前凸程度的椎间融合器在经椎间孔腰椎椎间融合术（TLIF）中产生节段性腰椎前凸（SLL）的效果。因此，我们旨在研究在开放TLIF手术中，与标准前凸椎间融合器相比，高前凸椎间融合器对SLL的影响。
回顾了2017年至2018年间由同一位外科医生进行开放TLIF手术的38例连续患者。20例患者使用“高前凸椎间融合器”（前凸20°），18例患者使用“标准前凸椎间融合器”（前凸6°）。23例患者接受单节段TLIF手术，15例接受双节段TLIF手术。术前、术后及1年随访时评估包括SLL在内的标准影像学测量指标。SLL是从上方椎体的上终板测量至下方椎体的下终板。使用学生t检验和配对t检验比较SLL的变化。
在单节段和双节段开放TLIF中，高前凸和标准前凸椎间融合器均使SLL有显著改善。在接受单节段TLIF的患者中，使用标准前凸椎间融合器的患者SLL增加7.8°（P = 0.024）；使用高前凸椎间融合器的患者增加8.2°（P = 0.020）。在接受双节段TLIF的患者中，使用标准前凸椎间融合器的患者SLL增加13.9°（P = 0.032）；使用高前凸椎间融合器的患者增加8.8°（P = 0.023）。然而，在单节段或双节段TLIF手术中，两种椎间融合器类型在SLL改善方面无显著差异（P = 0.917，P = 0.389）。在1年随访时，标准前凸和高前凸椎间融合器的SLL均无显著变化（P = 0.501，P = 0.781）。
尽管从理论上讲，在开放TLIF手术中高前凸椎间融合器比标准前凸椎间融合器能更多地增加SLL，但我们的数据未能证明这一点。由于我们的研究检查了在采用这些前凸椎间融合器之前和之后由同一位外科医生进行的病例，在改善SLL方面，手术技术可能比椎间融合器设计的前凸程度同等重要或更重要。
