Bokov Andrey, Kalinina Svetlana, Leontev Andrei, Mlyavykh Sergey
Department of Oncology and Neurosurgery, Privolzhsky Research Medical University, Nizhny Novgorod, Russia.
Department of Traumatology, Orthopedics and Neurosurgery, Privolzhsky Research Medical University, Nizhny Novgorod, Russia.
Front Surg. 2022 May 16;9:827999. doi: 10.3389/fsurg.2022.827999. eCollection 2022.
Different fusion techniques were introduced in clinical practice in patients with lumbar degenerative disc disease, however, no evidence has been provided on the advantages of one technique over another.
Is to assess the potential impact of circumferential fusion employing transforaminal lumbar interbody fusion (TLIF) vs. direct lateral interbody fusion (DLIF) on pedicle screw stability.
This is a single-center prospective evaluation of consecutive 138 patients with degenerative instability of lumbar spinal segments. Either conventional transforaminal lumbar interbody fusion (TLIF) with posterior fusion or direct lateral interbody fusion (DLIF) using cages of standard dimensions, were applied. The conventional open technique was used to supplement TLIF with pedicle screws while percutaneous screw placement was used in patients treated with DLIF. The duration of the follow-up accounted for 24 months. Signs of pedicle screws loosening (PSL) and bone union after fusion were assessed by the results of CT imaging. Fisher's exact test was used to assess the differences in the rate of CT loosening and revision surgery because of implant instability. Logistic regression was used to assess the association between potential factors and complication rate.
The rate of PSL detected by CT and relevant revision surgery in groups treated with TLIF and DLIF accounted for 25 (32.9%) vs. 2 (3.2%), respectively, for the former and 9 (12.0%) vs. 0 (0%) for the latter ( < 0.0001 and = 0.0043) respectively. According to the results of logistic regression, a decrease in radiodensity values and a greater number of levels fused were associated with a rise in PSL rate. DLIF application in patients with radiodensity below 140 HU was associated with a considerable decrease in complication rate. Unipolar or bipolar pseudoarthrosis in patients operated on with TLIF was associated with a rise in PSL rate while patients treated with DLIF tolerate delayed interbody fusion formation. In patients treated with TLIF supplementary total or partial posterior fusion resulted in a decline in PSL rate.
Even though the supplementary posterior fusion may considerably reduce the rate of PSL in patients treated with TLIF, the application of DLIF provide greater stability resulting in a substantial decline in PSL rate and relevant revision surgery.
腰椎间盘退变疾病患者的临床实践中引入了不同的融合技术，然而，尚无证据表明一种技术优于另一种技术。
是评估采用经椎间孔腰椎椎体间融合术（TLIF）与直接外侧椎体间融合术（DLIF）进行环形融合对椎弓根螺钉稳定性的潜在影响。
这是一项对138例连续性腰椎节段性退变不稳患者进行的单中心前瞻性评估。采用标准尺寸椎间融合器，应用后路融合的传统经椎间孔腰椎椎体间融合术（TLIF）或直接外侧椎体间融合术（DLIF）。传统开放技术用于为TLIF补充椎弓根螺钉，而DLIF治疗的患者采用经皮螺钉置入。随访时间为24个月。通过CT成像结果评估椎弓根螺钉松动（PSL）和融合后骨愈合的迹象。采用Fisher精确检验评估CT松动率和因植入物不稳定而进行翻修手术的差异。采用逻辑回归评估潜在因素与并发症发生率之间的关联。
TLIF组和DLIF组经CT检测的PSL率及相关翻修手术率，前者分别为25例（32.9%）对2例（3.2%），后者分别为9例（12.0%）对0例（0%）（分别为P<0.0001和P = 0.0043）。根据逻辑回归结果，骨密度值降低和融合节段数量增加与PSL率升高相关。在骨密度低于140 HU的患者中应用DLIF与并发症发生率显著降低相关。TLIF手术患者出现单极或双极假关节与PSL率升高相关，而DLIF治疗的患者可耐受延迟的椎间融合形成。在接受TLIF治疗的患者中，补充全椎板或部分后路融合可导致PSL率下降。
尽管补充后路融合可能会显著降低TLIF治疗患者的PSL率，但DLIF的应用提供了更大的稳定性，导致PSL率和相关翻修手术显著下降。
