Department of Orthopedics, The Second Affiliated Hospital, School of Medicine, Zhejiang University, No.88 Jiefang Road, Hangzhou, 310009, Zhejiang Province, China.
Department of Orthopedics, Zhuji People's Hospital of Zhejiang Province, Shaoxing, Zhejiang Province, China.
Int Orthop. 2022 May;46(5):1101-1109. doi: 10.1007/s00264-022-05313-4. Epub 2022 Feb 7.
To analyze the predictors for second-stage posterior direct decompression (PDD) after lateral lumbar interbody fusion (LLIF) procedure.
We studied patients who underwent LLIF for degenerative lumbar spinal stenosis in the last five years, from July 2016 to June 2021. All surgical levels were grouped according to Schizas' central canal stenosis (CCS) classification, Pathria's facet joint degeneration (FJD) classification, Bartynski's lateral recess stenosis (LRS) classification, and Lee's foraminal stenosis (FS) classification. Second-stage PDD rates of each subgroup and their annual change were analyzed. Evaluation of risk factors associated with PDD was investigated.
A total of 901 segments from 557 patients were included. The overall PDD rate was 29.97%. An overall PDD rate of 75.21% for grade D CCS, 29.74% for grade C CCS, 41.67% for grade 3 FJD, 37.61% for grade 3 LRS, and 40.70% for grade 3 FS was shown. While there was a continuous decline in annual PDD rate in the past four years, the annual PDD rate for grade D remained at very high levels. Logistic regression analysis had shown grade D CCS as the utmost risk factor for PDD (OR = 17.77). And grade 3 LRS (OR = 4.63), grade 3 FS (OR = 2.42), grade C CCS (OR = 2.41), and grade 3 FJD (OR = 2.04) were also moderately correlated with PDD, which meant they only moderately increased the risk of PDD.
Extreme severe lumbar CCS (grade D) is the greatest determinant to perform the second-stage PDD procedure after LLIF.
分析侧路腰椎间融合术（LLIF）后行二期后路直接减压（PDD）的预测因素。
我们研究了 2016 年 7 月至 2021 年 6 月期间因退行性腰椎管狭窄症行 LLIF 的患者。所有手术节段均根据 Schizas 椎管狭窄中央管狭窄（CCS）分级、Pathria 关节突关节退变（FJD）分级、Bartynski 侧隐窝狭窄（LRS）分级和 Lee 椎间孔狭窄（FS）分级进行分组。分析各亚组的二期 PDD 率及其年变化。并探讨与 PDD 相关的危险因素评估。
共纳入 557 例患者的 901 个节段。总体 PDD 率为 29.97%。CCS 分级 D 级总体 PDD 率为 75.21%，CCS 分级 C 级为 29.74%，FJD 分级 3 级为 41.67%，LRS 分级 3 级为 37.61%，FS 分级 3 级为 40.70%。虽然过去四年 PDD 年发生率呈持续下降趋势，但 D 级的 PDD 年发生率仍保持在较高水平。Logistic 回归分析显示，D 级 CCS 是 PDD 的最危险因素（OR=17.77）。而 LRS 分级 3 级（OR=4.63）、FS 分级 3 级（OR=2.42）、CCS 分级 C 级（OR=2.41）和 FJD 分级 3 级（OR=2.04）也与 PDD 中度相关，这意味着它们只是中度增加了 PDD 的风险。
极重度腰椎 CCS（D 级）是 LLIF 后行二期 PDD 术的最大决定因素。
