Alahmari Abdulmajeed, Thornley Patrick, Glennie Andrew, Urquhart Jennifer C, Al-Jahdali Fares, Rampersaud Raja, Fisher Charles, Siddiqi Fawaz, Rasoulinejad Parham, Bailey Christopher S
Division of Orthopaedics, Department of Surgery, Western University, London, ON, Canada.
Department of Orthopedics and Neurosurgery, Dalhousie University, Halifax, NS, Canada.
Global Spine J. 2024 Mar;14(2):610-619. doi: 10.1177/21925682221118845. Epub 2022 Aug 10.
Retrospective Cohort Study.
To determine the effect of interbody cages inserted via posterior approach on segmental lordosis in the setting of preoperative lordotic vs kyphotic discs in patients with lumbar degenerative spondylolisthesis (LDS).
Retrospective analysis of prospectively collected data on assessment and management of LDS patients from 2 contributing centres. Patients were analyzed preoperatively and at 12-month follow-up with standing lumbar radiographs. Index level segmental lumbar lordosis (SLL), disc angle and global lumbar lordosis was measured. Patients were stratified into 4 groups based on index level disc angle and procedure: preoperative lordotic posterolateral fusion (group L-PLF); preoperative kyphotic PLF (group K-PLF); preoperative lordotic interbody fusion (IF) (group L-IF); preoperative kyphotic IF (group K-IF).
A total of 100/111 (90%) patients completed follow-up with 40 in group L-IF and 48 in group K-IF. There were 18 patients in group L-PLF and 5 in group K-PLF. Among patients with preoperatively lordotic disc angles who had a worsening of SLL, group L-IF had worse SLL than group L-PLF patients, with differences persisting at one-year (mean difference 2.30, 95% CI, .3, 4.3, = .029). Patients in group K-IF achieved improvement in SLL at one-year more frequently than group L-IF (67% vs 44%, = .046), with similar mean improvement magnitude between groups L-IF and K-IF (-1.1, 95% CI, -3.7, 1.6, = .415).
Segmental lordosis worsening was greater with preoperative index lordotic disc angles when an interbody cage was used. Patients who have a kyphotic disc preoperatively gain more lordosis with interbody cage use.
回顾性队列研究。
确定在腰椎退行性滑脱（LDS）患者中，术前椎间盘前凸与后凸情况下，经后路植入椎间融合器对节段性前凸的影响。
对来自2个参与中心的LDS患者评估和管理的前瞻性收集数据进行回顾性分析。术前及术后12个月随访时，对患者进行站立位腰椎X线片检查。测量索引节段的腰椎节段性前凸（SLL）、椎间盘角度和整体腰椎前凸。根据索引节段椎间盘角度和手术方式将患者分为4组：术前前凸型后外侧融合术（L-PLF组）；术前后凸型PLF（K-PLF组）；术前前凸型椎间融合术（IF）（L-IF组）；术前后凸型IF（K-IF组）。
共有100/111例（90%）患者完成随访，其中L-IF组40例，K-IF组48例。L-PLF组18例，K-PLF组5例。在术前椎间盘前凸角度的患者中，SLL恶化的患者中，L-IF组的SLL比L-PLF组患者更差，差异持续1年（平均差异2.30，95%CI，0.3，4.3，P = 0.029）。K-IF组患者在1年时SLL改善的频率高于L-IF组（67%对44%，P = 0.046），L-IF组和K-IF组之间的平均改善幅度相似（-1.1，95%CI，-3.7，1.6，P = 0.415）。
使用椎间融合器时，术前索引前凸椎间盘角度的患者节段性前凸恶化更大。术前椎间盘后凸的患者使用椎间融合器可获得更多前凸。
