未融合节段的真空现象是否会影响腰椎曲度差值为正值的患者经椎间孔腰椎体间融合术后的病程？

Does vacuum phenomenon at non-fused discs affect the postoperative course after transforaminal lumbar interbody fusion in patients showing a positive value of difference in lumbar lordosis?

机构信息

Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Chiba, Japan.

Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Chiba, Japan; Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan.

出版信息

J Orthop Sci. 2024 Mar;29(2):472-479. doi: 10.1016/j.jos.2023.01.001. Epub 2023 Jan 24.

DOI:10.1016/j.jos.2023.01.001

PMID:36697335

Abstract

INTRODUCTION

Preoperative difference in lumbar lordosis (DiLL) was associated with surgical outcomes after single-level transforaminal lumbar interbody fusion (TLIF). Patients with DiLL>0 (DiLL (+)) tended to show worse clinical outcomes and postoperative greater restoration of lumbar lordosis (LL). However, some patients with DiLL (+) showed relatively good outcomes and no postoperative LL restration. This study aimed to elucidate whether the lumbar intervertebral disc vacuum phenomenon (VP) influences clinical course after single-level TLIF in patients with DiLL (+) and DiLL (-).

METHODS

Patients with lumbar spinal stenosis and degenerative spondylolisthesis treated with single-level TLIF were included. Pre- and postoperative LL were measured, and postoperative LL improvement was calculated. Preoperative DiLL was calculated as preoperative supine LL minus standing LL. Severity of VP at the non-fused discs (SVP (non-FS)) was evaluated using preoperative reconstructed computed tomography imaging. Clinical outcomes were assessed using the Oswestry disability index, visual analogue scale (VAS; low back pain (LBP), lower-extremity pain, numbness, and the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire. Patients were stratified by the median preoperative SVP (non-FS) score into severe and mild VP groups in patients with DiLL (+) or DiLL (-), and their surgical outcomes were compared.

RESULTS

Overall, 89 patients were included. In patients with DiLL (+) (n = 37), patients with severe VP showed worse clinical outcomes, particulary for LBP and DiLL (+) patients with mild VP showed greater LL improvement (6.5° ± 10.0°). In patients with DiLL(-) (n = 52), patients with severe VP showed worse clinical outcomes, particularly for LBP and no differences in preoperative, postoperative, and improvement of LL were observed between two groups.

CONCLUSION

Patients with DiLL (+) and DiLL (-) showed different clinical courses depending on VP severity at the non-fused discs after single-level TLIF.

摘要

介绍

术前腰椎前凸度（DiLL）的差异与单节段经椎间孔腰椎体间融合术（TLIF）后的手术结果相关。DiLL＞0（DiLL（+））的患者往往表现出更差的临床结果和术后腰椎前凸度（LL）更大的恢复。然而，一些 DiLL（+）的患者表现出相对较好的结果和术后 LL 无恢复。本研究旨在阐明腰椎间盘真空现象（VP）是否会影响 DiLL（+）和 DiLL（-）患者单节段 TLIF 后的临床病程。

方法

纳入接受单节段 TLIF 治疗的腰椎管狭窄症和退行性腰椎滑脱症患者。测量术前和术后 LL，并计算术后 LL 的改善情况。术前 DiLL 计算为术前仰卧位 LL 减去站立位 LL。使用术前重建 CT 图像评估非融合节段的 VP 严重程度（SVP（非 FS））。临床结果使用 Oswestry 残疾指数、视觉模拟评分（VAS；下腰痛（LBP）、下肢疼痛、麻木和日本矫形协会腰痛评估问卷进行评估。根据术前 SVP（非 FS）评分中位数将 DiLL（+）或 DiLL（-）的患者分为严重和轻度 VP 组，并比较其手术结果。

结果

总体而言，纳入 89 例患者。在 DiLL（+）的患者中（n=37），严重 VP 患者的临床结果较差，特别是 LBP 和 DiLL（+）的患者，轻度 VP 患者的 LL 改善更大（6.5°±10.0°）。在 DiLL（-）的患者中（n=52），严重 VP 患者的临床结果较差，特别是 LBP，两组间术前、术后和 LL 改善无差异。