节段性椎间融合器后凸角度和位置是否影响单节段经椎间孔腰椎体间融合术后的影像学结果？

Does Interbody Cage Lordosis and Position Affect Radiographic Outcomes After Single-level Transforaminal Lumbar Interbody Fusion?

机构信息

Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA.

出版信息

Clin Spine Surg. 2022 Nov 1;35(9):E674-E679. doi: 10.1097/BSD.0000000000001334. Epub 2022 Apr 5.

DOI:10.1097/BSD.0000000000001334

PMID:35383604

Abstract

STUDY DESIGN

This was a retrospective cohort study.

OBJECTIVE

The objective of this study was to determine if the degree of interbody cage lordosis and cage positioning are associated with changes in postoperative sagittal alignment after single-level transforaminal lumbar interbody fusion (TLIF).

SUMMARY OF BACKGROUND DATA

Ideal sagittal alignment and lumbopelvic alignment have been shown to correlate with postoperative clinical outcomes. TLIF is one technique that may improve these parameters, but whether the amount of cage lordosis improves either segmental or lumbar lordosis (LL) is unknown.

METHODS

A retrospective review was performed on patients who underwent single-level TLIF with either a 5-degree or a 12-degree lordotic cage. LL, segmental lordosis (SL), disk height, center point ratio, cage position, and cage subsidence were evaluated. Correlation between center point ratio and change in lordosis was assessed using the Spearman correlation coefficient. Secondary analysis included multiple linear regression to determine independent predictors of change in SL.

RESULTS

A total of 126 patients were included in the final analysis, with 51 patients receiving a 5-degree cage and 75 patients receiving a 12-degree cage. There were no differences in the postoperative minus preoperative LL (∆LL) (12-degree cage: -1.66 degrees vs. 5-degree cage: -2.88 degrees, P =0.528) or ∆SL (12-degree cage: -0.79 degrees vs. 5-degree cage: -1.68 degrees, P =0.513) at 1-month follow-up. Furthermore, no differences were found in ∆LL (12-degree cage: 2.40 degrees vs. 5-degree cage: 1.00 degrees, P =0.497) or ∆SL (12-degree cage: 1.24 degrees vs. 5-degree cage: 0.35 degrees, P =0.541) at final follow-up. Regression analysis failed to show demographic factors, cage positioning, or cage lordosis to be independent predictors of change in SL. No difference in subsidence was found between groups (12-degree cage: 25.5% vs. 5-degree cage: 32%, P =0.431).

CONCLUSION

Lordotic cage angle and cage positioning were not associated with perioperative changes in LL, SL, or cage subsidence after single-level TLIF.

LEVEL OF EVIDENCE

Level III.

摘要

研究设计

这是一项回顾性队列研究。

目的

本研究旨在确定椎间笼前凸度和笼位是否与单节段经椎间孔腰椎体间融合术（TLIF）后矢状位排列的变化有关。

背景资料总结

理想的矢状位和腰骨盆排列与术后临床结果相关。TLIF 是一种可能改善这些参数的技术，但椎间笼前凸度的增加是否能改善节段性或腰椎前凸（LL）尚不清楚。

方法

对接受 5 度或 12 度前凸椎间笼的单节段 TLIF 患者进行回顾性分析。评估 LL、节段前凸（SL）、椎间盘高度、中心点比值、笼位和笼下沉。使用 Spearman 相关系数评估中心点比值与前凸变化之间的相关性。二次分析包括多元线性回归，以确定 SL 变化的独立预测因子。

结果

共纳入 126 例患者进行最终分析，51 例患者接受 5 度笼，75 例患者接受 12 度笼。术后 1 个月时，LL 的术后与术前差值（∆LL）（12 度笼：-1.66 度 vs. 5 度笼：-2.88 度，P =0.528）或 SL 的 ∆SL（12 度笼：-0.79 度 vs. 5 度笼：-1.68 度，P =0.513）无差异。此外，最终随访时，∆LL（12 度笼：2.40 度 vs. 5 度笼：1.00 度，P =0.497）或 ∆SL（12 度笼：1.24 度 vs. 5 度笼：0.35 度，P =0.541）也无差异。回归分析未能显示出人口统计学因素、笼位或笼前凸度是 SL 变化的独立预测因子。两组间的沉降差异无统计学意义（12 度笼：25.5% vs. 5 度笼：32%，P =0.431）。