Scott-Young Matthew, McEntee Laurence, Rathbone Evelyne, Nielsen David, Grierson Lauren, Hing Wayne
Gold Coast Spine, Gold Coast, QLD, Australia
Faculty of Health Science & Medicine, Bond University, Gold Coast, QLD, Australia.
Int J Spine Surg. 2022 Jul 25;16(5):847-58. doi: 10.14444/8331.
The literature reports that index level (IL) revision spine surgery (RSS) and adjacent level (AL) RSS are diminished in lumbar TDR compared with fusion procedures. There is a paucity of PROMs reported after RSS.
To present the incidence of RSS at the IL and AL following single-level lumbar total disc replacement (TDR) and to document patient-related outcome measures (PROMs) associated with RSS.
PROMs and timelines were analyzed for 32 RSS patients from a prospective cohort study of 401 patients treated with TDR for single-level degenerative disc disease. The data collected prospectively are analyzed from baseline (prior to index surgery) to latest follow-up following RSS. PROMs, including visual analog scales for back and leg, Oswestry Disability Index, and Roland-Morris Disability Questionnaire, were collected preoperatively; postoperatively at 3, 6, and 12 months; and annually thereafter until RSS. The time to RSS was recorded, and PROMs for RSS (IL, AL, or both) were documented, analyzed, and compared.
The median time to RSS in the IL cohort was 35 months (interquartile range [IQR] = 9-51 months). The median time to RSS cohort was 70 months (IQR = 41.3-105.3 months). Timepoints facilitate PROM discussion for RSS. Patients in both groups achieved thresholds for the minimum clinically important difference for pain and disability scores. The small sample size in each group contributed to the variability demonstrated by the 95% CIs, thereby cautioning definitive conclusions.
This study reveals that statistically significant and modest clinical improvements in PROMs can be achieved in RSS for lumbar TDR at IL and AL. The surgical approach and technique are reflective of the pathology and suggest that anterior RSS for AL degeneration and posterior RSS for IL pathology yield similar results.
Statistical and clinical improvements can be achieved in IL-RSS and AL-RSS following single level TDR. It is essential for clinicians to understand and verify the underlying IL and/or AL pathology to select an appropriate management strategy and to facilitate balanced informed discussions with patients.
文献报道，与融合手术相比，腰椎人工椎间盘置换术（TDR）中索引节段（IL）翻修脊柱手术（RSS）和相邻节段（AL）RSS的发生率较低。关于RSS术后患者报告结局测量（PROMs）的报道较少。
介绍单节段腰椎全椎间盘置换术（TDR）后IL和AL节段RSS的发生率，并记录与RSS相关的患者相关结局测量指标（PROMs）。
对401例因单节段退变性椎间盘疾病接受TDR治疗的患者进行前瞻性队列研究，分析其中32例RSS患者的PROMs和时间线。对前瞻性收集的数据从基线（索引手术前）到RSS后的最新随访进行分析。术前、术后3、6和12个月以及此后每年直至RSS时收集PROMs，包括背部和腿部视觉模拟量表、Oswestry功能障碍指数和Roland-Morris功能障碍问卷。记录RSS发生时间，并记录、分析和比较RSS（IL、AL或两者）的PROMs。
IL队列中RSS的中位时间为35个月（四分位间距[IQR]=9-51个月）。AL队列中RSS的中位时间为70个月（IQR=41.3-105.3个月）。时间点有助于对RSS进行PROM讨论。两组患者的疼痛和残疾评分均达到最小临床重要差异阈值。每组的小样本量导致95%可信区间显示出变异性，因此需谨慎得出明确结论。
本研究表明，腰椎TDR的IL和AL节段RSS在PROMs方面可实现具有统计学意义的适度临床改善。手术入路和技术反映了病理情况，提示AL退变采用前路RSS，IL病理采用后路RSS可产生相似结果。
单节段TDR后的IL-RSS和AL-RSS可实现统计学和临床改善。临床医生必须了解并核实潜在的IL和/或AL病理情况，以选择合适的治疗策略，并促进与患者进行平衡的知情讨论。
