接受后路腰椎椎间融合术患者的临床和影像学结果：单侧和双侧 cage 置入的比较。
Clinical and radiological outcomes in patients who underwent posterior lumbar interbody fusion: comparisons between unilateral and bilateral cage insertion.
机构信息
Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1, PungNap-2-dong, SongPa-gu, Seoul, South Korea.
出版信息
BMC Musculoskelet Disord. 2021 Nov 17;22(1):963. doi: 10.1186/s12891-021-04852-y.
BACKGROUND
Although the original technique involves inserting two cages bilaterally, there could be situations that only allow for insertion of one cage unilaterally. However, only a few studies have compared the outcomes between unilateral and bilateral cage insertion. The purpose of this study was to compare the clinical and radiological outcomes in patients who underwent posterior lumbar interbody fusion (PLIF) between unilaterally and bilaterally inserted cages.
METHODS
Among 206 eligible patients who underwent 1- or 2-level PLIF, 78 patients were 1:3 cohort-matched by age, sex, and operation level (group U, 19 patients with unilateral cages; and group B, 57 patients with bilateral cages). Fusion status was evaluated by computed tomography (CT) scans at postoperative 1 year. Clinical outcomes were measured by visual analog scale (VAS), Oswestry Disability Index (ODI), and EQ-5D. Radiological and clinical parameters were compared between the two groups. Risk factors for pseudarthrosis were also analyzed by multivariate analysis.
RESULTS
The demographic data were not significantly different between the two groups. However, previous laminectomy, asymmetric disc collapse, and fusion at L5-S1 level were more frequently found in group U (P = 0.003, P = 0.014, and P = 0.014, respectively). Furthermore, pseudarthrosis was more frequently observed in group U (36.8%) than in group B (7.0%) (P = 0.004). Back pain VAS was higher in group U at postoperative 1 year (P = 0.033). Lower general activity function of EQ-5D was observed in group U at postoperative 1 year (P = 0.035). Older age (P = 0.028), unilateral cage (P = 0.007), and higher bone mineral density (P = 0.033) were positively correlated with pseudarthrosis.
CONCLUSIONS
Unilaterally inserted cage might be a possible risk factor for pseudarthrosis when performing PLIF, which could be related with the difficult working conditions such as scars due to previous laminectomy or asymmetric disc collapse. Furthermore, suboptimal clinical outcomes are expected following PLIF with unilateral cage insertion at postoperative 1 year regardless of similar clinical outcomes at postoperative 2 year. Therefore, caution is advised when inserting cages unilaterally, especially under above-mentioned conditions in terms of its possible relationship with symptomatic pseudarthrosis.
背景
虽然原始技术涉及双侧插入两个 cage，但有时可能只允许单侧插入一个 cage。然而，只有少数研究比较了单侧和双侧 cage 插入的结果。本研究旨在比较单侧和双侧插入 cage 行后路腰椎间融合术（PLIF）患者的临床和影像学结果。
方法
在 206 例符合条件的行 1 或 2 节段 PLIF 的患者中，根据年龄、性别和手术节段，78 例患者按 1:3 比例进行队列匹配（单侧 cage 组，U 组，19 例；双侧 cage 组，B 组，57 例）。术后 1 年通过计算机断层扫描（CT）评估融合状态。采用视觉模拟评分（VAS）、Oswestry 功能障碍指数（ODI）和 EQ-5D 评估临床结果。比较两组之间的影像学和临床参数。通过多因素分析还分析了假关节形成的危险因素。
结果
两组患者的人口统计学数据无显著差异。然而，U 组中更常见既往椎板切除术、不对称椎间盘塌陷和 L5-S1 融合（P=0.003、P=0.014 和 P=0.014）。此外，U 组的假关节发生率（36.8%）明显高于 B 组（7.0%）（P=0.004）。术后 1 年，U 组的腰痛 VAS 评分更高（P=0.033）。术后 1 年，U 组的 EQ-5D 一般活动功能较低（P=0.035）。年龄较大（P=0.028）、单侧 cage（P=0.007）和较高的骨密度（P=0.033）与假关节呈正相关。
结论
在行 PLIF 时，单侧插入 cage 可能是假关节形成的一个潜在危险因素，这可能与既往椎板切除术引起的疤痕或不对称椎间盘塌陷等困难的手术条件有关。此外，无论术后 2 年的临床结果相似，单侧 cage 插入的 PLIF 术后 1 年的临床结果预计不佳。因此，在行单侧 cage 插入时应谨慎，特别是在上述情况下，可能与症状性假关节有关。
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