Matsukawa Keitaro, Fujiyoshi Kanehiro, Yanai Yoshihide, Kato Takashi, Yato Yoshiyuki
Department of Orthopaedic Surgery, National Hospital Organization, Murayama Medical Center, Tokyo, Japan.
Spine Surg Relat Res. 2022 Feb 10;6(5):480-487. doi: 10.22603/ssrr.2021-0207. eCollection 2022 Sep 27.
Vertebral slip reduction has been recommended in arthrodesis for lumbar degenerative spondylolisthesis (LDS) to achieve balanced spinal alignment and bone fusion. However, what determines the degree of slip reduction using cortical bone trajectory technique for lumbar pedicle screw insertion is yet to be determined. Thus, in this study, we aim to investigate the slip reduction capacity using cortical bone trajectory (CBT) technique and to identify factors affecting the slip reduction rate.
This is a retrospective radiological evaluation of prospectively collected patients. In total, 49 consecutive patients who underwent single-level transforaminal lumbar interbody fusion for LDS using the CBT technique were included (mean follow-up: 28.9 months). Firstly, radiological parameters of fused segment including the percentage of anterior vertebral slip (%slip), lordotic angle, and disk height were measured. Then, patient and procedure-related parameters were examined to determine factors related to the slip reduction rate using multiple regression analysis.
The %slip was reduced from 15.0±4.8 to 1.6±2.3% immediately after surgery and 2.2±2.9% at the last follow-up (p<0.01), with a slip reduction rate of 87.5±15.7% and correction loss of 0.6±2.1%. As per multivariate regression analysis, it was found that preoperative %slip (standardized regression coefficient [β]=-0.55, p=0.003) and the depth of screw insertion in the caudal vertebra (β=0.38, p=0.03) were significant independent factors affecting slip reduction rate (adjusted R=0.29, p=0.008).
To the best of our knowledge, this study is the first to investigate the capacity for and factors affecting slip reduction using the CBT technique for LDS. The CBT technique may be a useful option for achieving slip reduction, and the depth of screw insertion in the caudal vertebra was identified as a significant technical factor to obtain a more significant reduction of slipped vertebra.
在腰椎退行性椎体滑脱（LDS）的关节融合术中，推荐进行椎体滑移复位以实现脊柱平衡排列和骨融合。然而，使用皮质骨轨迹技术进行腰椎椎弓根螺钉置入时，决定滑移复位程度的因素尚未确定。因此，在本研究中，我们旨在研究使用皮质骨轨迹（CBT）技术的滑移复位能力，并确定影响滑移复位率的因素。
这是一项对前瞻性收集患者的回顾性影像学评估。总共纳入了49例连续接受单节段经椎间孔腰椎椎间融合术治疗LDS并使用CBT技术的患者（平均随访时间：28.9个月）。首先，测量融合节段的影像学参数，包括椎体前滑移百分比（%滑移）、前凸角和椎间盘高度。然后，检查患者和手术相关参数，使用多元回归分析确定与滑移复位率相关的因素。
术后即刻%滑移从15.0±4.8降至1.6±2.3%，末次随访时为2.2±2.9%（p<0.01），滑移复位率为87.5±15.7%，矫正丢失为0.6±2.1%。根据多变量回归分析，发现术前%滑移（标准化回归系数[β]= -0.55，p = 0.003）和尾侧椎体螺钉置入深度（β = 0.38，p = 0.03）是影响滑移复位率的显著独立因素（调整R = 0.29，p = 0.008）。
据我们所知，本研究是首次调查使用CBT技术治疗LDS的滑移复位能力及影响因素。CBT技术可能是实现滑移复位的有用选择，并且尾侧椎体螺钉置入深度被确定为获得更显著椎体滑移复位的重要技术因素。
