Yamada Katsuhisa, Nagahama Ken, Abe Yuichiro, Murota Eihiro, Hiratsuka Shigeto, Takahata Masahiko, Iwasaki Norimasa
Department of Orthopaedic Surgery, Hokkaido University Hospital, Sapporo, Japan.
Department of Orthopaedic Surgery, Wajokai Sapporo Hospital, Sapporo, Japan.
Spine Surg Relat Res. 2021 Apr 14;5(6):390-396. doi: 10.22603/ssrr.2020-0232. eCollection 2021.
A percutaneous endoscopic transforaminal lumbar interbody fusion (PETLIF) procedure has been previously developed. During postoperative follow-up, in some patients, bone fusion occurred between opened facet joints, despite not having bone grafting in the facet joints. Here, we investigated facet fusion's frequency and tendencies following PETLIF.
A retrospective analysis was conducted on a prospectively collected, nonrandomized series of patients. Forty-two patients (6 males and 36 females, average age: 69.9 years) who underwent single-level PETLIF at our hospital from February 2016 to March 2019 were included in this study. Patients were assessed with lumbar X-ray images and computed tomography (CT) prior to, immediately after, and 1 year after surgery.
Pseudarthrosis was not observed in any patients, and facet fusion was observed in 26 of 42 post-PETLIF patients (61.9%) by CT 1 year postoperatively. The average interfacet distance increased from 1.3 mm preoperatively to 4.5 mm postoperatively, and facet fusion was observed under the opened conditions of 3.8 mm at 1 year. Segmental lordotic angle of the fusion segment in the lumbar X-ray images was significantly larger in the facet fusion subgroup prior to surgery, immediately following surgery, and 1 year after surgery compared to the facet non-fusion group (p=0.02, p<0.01, p=0.01, respectively). There were no significant differences in patient background, correction loss of segmental lordosis, interfacet distance, or clinical score between the facet fusion and facet non-fusion subgroups.
Facet fusion was achieved over time within the facet joints that were opened through indirect decompression after PETLIF. We hypothesized that the preserved facet joints potentially became the base bed for spontaneous bone fusion due to the preserved facet joint capsule and surrounding soft tissue, which maintained cranio-caudal facet traffic and blood circulation in the facet joints. The complete preservation of the facet joints was a key advantage of minimally invasive lumbar interbody fusion procedures.
Level III.
经皮内镜下经椎间孔腰椎椎间融合术（PETLIF）此前已被研发出来。在术后随访过程中，部分患者尽管未在小关节进行植骨，但在开放的小关节之间仍发生了骨融合。在此，我们对PETLIF术后小关节融合的发生率及趋势进行了研究。
对前瞻性收集的非随机患者系列进行回顾性分析。本研究纳入了2016年2月至2019年3月在我院接受单节段PETLIF手术的42例患者（6例男性，36例女性，平均年龄：69.9岁）。在手术前、术后即刻及术后1年对患者进行腰椎X线片及计算机断层扫描（CT）评估。
所有患者均未观察到假关节形成，术后1年通过CT观察到42例PETLIF术后患者中有26例（61.9%）发生了小关节融合。术前平均椎间距离为1.3mm，术后增加至4.5mm，术后1年在开放条件下3.8mm时观察到小关节融合。与小关节未融合组相比，腰椎X线片上融合节段的节段性前凸角在术前、术后即刻及术后1年时，小关节融合亚组均显著更大（分别为p = 0.02、p < 0.01、p = 0.01）。小关节融合亚组与小关节未融合亚组在患者背景、节段性前凸矫正丢失、椎间距离或临床评分方面均无显著差异。
PETLIF术后通过间接减压开放的小关节内随着时间推移实现了小关节融合。我们推测，保留的小关节由于保留了小关节囊及周围软组织，可能成为了自发骨融合的基础床，维持了小关节内的头尾向小关节交通及血液循环。小关节的完整保留是微创腰椎椎间融合手术的关键优势。
三级。
