Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA.
Clin Spine Surg. 2023 Aug 1;36(7):E324-E328. doi: 10.1097/BSD.0000000000001373. Epub 2022 Aug 11.
Retrospective Comparative Study.
The purpose of this study was to characterize trends in surgical approach for single-level lumbar fusion over the past decade.
The number of elective lumbar fusion cases performed is increasing annually. Several different surgical approaches exist for lumbar spinal fusion including novel anterior approaches developed in recent years. With ongoing innovation, trends in the utilization of common surgical approaches in recent years are unclear.
A retrospective cohort study was conducted using the PearlDiver database (Fort Wayne, IN). Patients undergoing single-level lumbar fusion between 2010 and 2019 were identified using Current Procedural Technology codes and divided into 4 mutually exclusive cohorts based on surgical approach: (1) anterior-only, (2) anterior approach with posterior instrumentation, (3) posterolateral, and (4) posterior-only interbody. Trend analyses of surgical approach utilization over the last decade were performed with the Cochran-Armitage test to evaluate the 2-tailed null hypothesis that utilization of each surgical approach for single-level lumbar fusion remained constant.
A total of 53,234 patients met inclusion criteria and were stratified into 4 cohorts: anterior-only (n=5104), anterior with posterior instrumentation (n=23,515), posterolateral (n=5525), and posterior-only interbody (n=19,090). Trend analysis revealed the utilization of a posterior-only interbody approach significantly decreased from 36.7% to 29.2% ( P <0.001), whereas the utilization of a combined anterior and posterior approach significantly increased from 45.8% to 50.4% ( P <0.001). The utilization of an anterior-only approach also significantly increased from 7.9% to 10.5% ( P <0.001).
Utilization of anterior-only and anterior with posterior instrumentation approaches for single-level lumbar fusion have been significantly increasing over the past decade while use of posterior-only interbody approach trended significantly downward. These data may be particularly useful for trainees and spine surgeons as new techniques and technology become available.
Level III-retrospective cohort study.
回顾性比较研究。
本研究旨在描述过去十年中单节段腰椎融合术手术入路的变化趋势。
每年接受选择性腰椎融合术的病例数量都在增加。腰椎脊柱融合术有几种不同的手术入路，包括近年来新开发的新型前路入路。随着不断创新，近年来常见手术入路的应用趋势尚不清楚。
使用 PearlDiver 数据库（印第安纳州韦恩堡）进行回顾性队列研究。使用当前手术技术代码识别 2010 年至 2019 年间接受单节段腰椎融合术的患者，并根据手术入路将患者分为 4 个互斥队列：（1）前路入路，（2）前路联合后路内固定，（3）后外侧入路，（4）后路单纯椎间融合。采用 Cochran-Armitage 检验进行过去十年手术入路利用情况的趋势分析，以检验单节段腰椎融合术各手术入路利用情况保持不变的双侧零假设。
共有 53234 例患者符合纳入标准，分为 4 个队列：前路入路（n=5104）、前路联合后路内固定（n=23515）、后外侧入路（n=5525）和后路单纯椎间融合（n=19090）。趋势分析显示，后路单纯椎间融合入路的使用率从 36.7%降至 29.2%（P<0.001），而前路联合后路入路的使用率从 45.8%升至 50.4%（P<0.001）。前路入路的使用率也从 7.9%升至 10.5%（P<0.001）。
过去十年中单节段腰椎融合术前路入路和前路联合后路内固定入路的应用明显增加，而后路单纯椎间融合入路的应用呈明显下降趋势。这些数据对于新的技术和技术的应用可能特别有用。
三级——回顾性队列研究。
