Department of Orthopaedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, PR China.
Orthopaedics Research Institute, Zhejiang University, Hangzhou City, Zhejiang Province, PR China.
Orthop Surg. 2022 Sep;14(9):2219-2229. doi: 10.1111/os.13441. Epub 2022 Aug 18.
The objective of this study was to introduce a retractor that can be temporarily installed on unilateral pedicle screws to achieve distraction-reduction and nerve root protection, and to analyze the efficacy and safety of retractor-assisted transforaminal lumbar interbody fusion (TLIF) in the treatment of lumbar spondylolisthesis.
This was a retrospective study of 125 patients who underwent retractor-assisted TLIF for single-segment spondylolisthesis from November 2017 to February 2021. Based on morphology, patients were divided into degenerative (N = 66) and isthmic groups (N = 59). Differences in demographics and preoperative characteristics between the groups were analyzed using the independent samples t-test and χ test. Changes in radiographic parameters (disc height, foramen height, spondylolisthesis degree, slippage length, and segmental lordosis) before and after surgery were compared using the paired samples t-test. Logistic regression analysis was performed to analyze the relationship between facet joint angle (FJA) and degenerative lumbar spondylolisthesis (DLS).
Unilateral screw retractor-assisted TLIF significantly corrected spondylolisthesis and improved disc height and segmental lordosis (p < 0.05). There was no significant difference in foramen height between the two sides before and after operation (pre: 15.81 ± 3.58 mm vs 15.69 ± 3.68 mm, p = 0.599; post: 18.65 ± 2.31 mm vs 18.74 ± 2.26 mm, p = 0.516). The degree of spondylolisthesis in the DLS group before surgery was significantly lower than that in the isthmic spondylolisthesis group (17.70 ± 5.62% vs 25.18 ± 9.73%, p < 0.001), whereas a similar degree of correction could be achieved after surgery (5.91 ± 3.12% vs 7.16 ± 5.69%, p = 0.135). FJAs from L3/4 to L5/S1 were significantly smaller in patients with DLS than those in with isthmic spondylolisthesis (p < 0.05). Patients with facet sagittalization were more likely to have DLS (β: -0.101, odds ratio [OR]:0.904, 95% confidence interval [CI]: 0.874-0.934, p < 0.001), while the cut-off FJA of L4/5 for predicting L4 spondylolisthesis was 53.19.
Pedicle screw retractor-assisted TLIF is effective and safe in treating both degenerative and isthmic lumbar spondylolisthesis. The unilateral retractor has the capacity to maintain the disc height achieved by paddle distractors, which optimizes the nerve protection and distractor placement. Patients with an FJA on L4/5 <53.19 were more likely to have DLS.
本研究旨在介绍一种可临时安装在单侧椎弓根螺钉上的牵开器，以实现牵开减压和神经根保护，并分析牵开器辅助经椎间孔腰椎体间融合术（TLIF）治疗腰椎滑脱症的疗效和安全性。
这是一项回顾性研究，纳入了 2017 年 11 月至 2021 年 2 月期间因单节段滑脱接受牵开器辅助 TLIF 治疗的 125 例患者。根据形态学，将患者分为退行性（N=66）和峡部裂组（N=59）。采用独立样本 t 检验和 χ 检验分析两组间的人口统计学和术前特征差异。采用配对样本 t 检验比较手术前后影像学参数（椎间盘高度、椎间孔高度、滑脱程度、滑脱长度和节段前凸角）的变化。采用 logistic 回归分析分析关节突角（FJA）与退行性腰椎滑脱（DLS）的关系。
单侧螺钉牵开器辅助 TLIF 可显著矫正滑脱并改善椎间盘高度和节段前凸角（p<0.05）。术后两侧椎间孔高度无显著差异（术前：15.81±3.58mm比 15.69±3.68mm，p=0.599；术后：18.65±2.31mm比 18.74±2.26mm，p=0.516）。DLS 组术前滑脱程度明显低于峡部裂性滑脱组（17.70±5.62%比 25.18±9.73%，p<0.001），但术后可达到相似的矫正程度（5.91±3.12%比 7.16±5.69%，p=0.135）。与峡部裂性滑脱相比，DLS 患者的 L3/4 至 L5/S1 的 FJA 明显更小（p<0.05）。关节突矢状化患者更易发生 DLS（β：-0.101，优势比[OR]：0.904，95%置信区间[CI]：0.874-0.934，p<0.001），而预测 L4 滑脱的 L4/5 截骨 FJA 为 53.19。
经皮螺钉牵开器辅助 TLIF 治疗退行性和峡部裂性腰椎滑脱症均有效且安全。单侧牵开器有能力维持桨式牵开器所达到的椎间盘高度，从而优化神经保护和牵开器放置。FJA 小于 53.19 的 L4/5 患者更易发生 DLS。
