Georgiou Stephen, Saggi Satvir, Wu Hao-Hua, Metz Lionel
Department of Orthopedic Surgery, at the University of California at San Francisco, San Francisco, California.
N Am Spine Soc J. 2022 May 21;10:100127. doi: 10.1016/j.xnsj.2022.100127. eCollection 2022 Jun.
For the surgical treatment of single-level degenerative spondylolisthesis (DS), patients can be treated with either an anterior or posterior interbody fusion. Prior studies have shown that patients with symptomatic degenerative spondylolisthesis treated surgically maintain substantially greater pain relief and improvement in function when compared to those treated non-operatively, but no consensus has emerged between which approach results in the best outcomes.
The PearlDiver MARINER database was queried for patients with single-level DS who underwent either an anterior or posterior lumbar interbody fusion. Both populations were compared on multiple outcomes, including reoperation, post-operative complications, and readmission rates at 90 days, as well as rates of reoperation and cauda equina syndrome two-years postoperatively.
At 90 days patients who underwent anterior interbody were found to have higher rates of DVT (OR 2.53, 95% CI 1.74 - 3.70, p<0.001), ileus (OR 1.43, 95% CI 1.25 - 1.64, p<0.001), and readmission (OR 1.28, 95% CI 1.19 - 1.38, p<0.001). Patients who underwent posterior interbody fusion were found to have higher rates of revision procedures (OR 0.63, 95% CI 0.59 - 0.66, p<0.001), transfusion (OR 0.68, 95% CI 0.58 - 0.78, p<0.001), acute kidney injury (OR 0.84, 95% CI 0.75 - 0.95, p=0.0046), and cauda equina syndrome (OR 0.53, 95% CI 0.40 - 0.69, p<0.001). At 2 years, patients who underwent posterior fusion required revision procedures (OR 0.70, 95% CI 0.67 - 0.74, p<0.001) and developed cauda equina syndrome (OR 0.62, 95% CI 0.50 - 0.77, p<0.001) at a higher rate than those who underwent anterior fusion.
Patients who underwent anterior interbody fusion for treatment of degenerative spondylolisthesis were found to have increased rates of DVT, ileus, and were more likely to be readmitted to the hospital within 90 days, while patients who underwent posterior interbody fusion were found to have higher rates of reoperation, transfusion, AKI, and cauda equina syndrome. Increased rates of reoperation and development of cauda equina in the posterior fusion group persisted at 2 years post-operatively.
对于单节段退变性腰椎滑脱（DS）的手术治疗，患者可接受前路或后路椎间融合术。既往研究表明，与非手术治疗的患者相比，接受手术治疗的有症状的退变性腰椎滑脱患者在疼痛缓解和功能改善方面有显著更大的效果，但对于哪种方法能带来最佳结果尚未达成共识。
在PearlDiver MARINER数据库中查询接受前路或后路腰椎椎间融合术的单节段DS患者。对这两组人群在多个结局指标上进行比较，包括再次手术、术后并发症、90天再入院率，以及术后两年的再次手术率和马尾神经综合征发生率。
在90天时，接受前路椎间融合术的患者深静脉血栓形成率更高（比值比2.53，95%置信区间1.74 - 3.70，p<0.001）、肠梗阻发生率更高（比值比1.43，95%置信区间1.25 - 1.64，p<0.001）和再入院率更高（比值比1.28，95%置信区间1.19 - 1.38，p<0.001）。接受后路椎间融合术的患者翻修手术率更高（比值比0.63，95%置信区间0.59 - 0.66，p<0.001）、输血率更高（比值比0.68，95%置信区间0.58 - 0.78，p<0.001）、急性肾损伤发生率更高（比值比0.84，95%置信区间0.75 - 0.95，p = 0.0046）和马尾神经综合征发生率更高（比值比0.53，95%置信区间0.40 - 0.69，p<0.001）。在术后2年，接受后路融合术的患者需要翻修手术（比值比0.70，95%置信区间0.67 - 0.74，p<0.001）且发生马尾神经综合征（比值比0.62，95%置信区间0.50 - 0.77，p<0.001）的发生率高于接受前路融合术的患者。
接受前路椎间融合术治疗退变性腰椎滑脱的患者深静脉血栓形成、肠梗阻发生率增加，且在90天内更有可能再次入院，而接受后路椎间融合术的患者翻修手术、输血、急性肾损伤和马尾神经综合征发生率更高。后路融合组术后2年翻修手术率和马尾神经综合征发生率仍持续较高。
