Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea.
Spine (Phila Pa 1976). 2023 Nov 15;48(22):1617-1625. doi: 10.1097/BRS.0000000000004523. Epub 2022 Nov 2.
A retrospective observational study.
This study investigated the clinical and radiological results of using cortical bone trajectory (CBT) screws versus traditional pedicle (TP) screws in transforaminal lumbar interbody fusion (TLIF) during a five-year follow-up of patients with single-level lumbar degenerative spondylolisthesis.
Few studies have compared five-year follow-up outcomes between CBT screws and TP screws in TLIF.
We reviewed outcome data of patients with single-level lumbar degenerative spondylolisthesis who underwent TLIF procedures with CBT screws (131 patients) or TP screws (80 patients) between 2011 and 2015. Patient-reported clinical outcome data included Oswestry disability index scores and visual analog scale (VAS) scores for back and leg pain at baseline, six months, and one year, two years, and five years postoperatively. The radiographic fusion rate and prevalence of secondary surgery for adjacent segment disease were also measured.
During the follow-up over five years, the CBT group had significantly lower VAS scores for back pain ( P <0.0001, respectively). At two years after surgery, the CBT group had significantly higher VAS scores for leg pain ( P =0.007). At five years postoperatively, no significant differences existed in the VAS score for leg pain or in the Oswestry disability index score between the two groups. Radiographic fusion rates (CBT vs. TP: 95.5% vs. 95.9%; P =0.881) and adverse events during the five years after surgery were not significantly different. At two years postoperatively, the prevalence of secondary surgery to treat adjacent segment disease was significantly different between the two groups (CBT vs . TP: 13.7% vs. 5.0%; P =0.044).
Our results suggest that, during a five-year followup, CBT screws for TLIF were an effective treatment compared to TP screws in the setting of single-level lumbar degenerative spondylolisthesis. However, when using CBT screws for TLIF, surgeons should consider the higher rate of secondary procedures to treat symptomatic adjacent segment disease.
回顾性观察研究。
本研究通过对接受单节段腰椎退变性滑脱经皮椎间孔腰椎间融合术（TLIF）的患者进行为期 5 年的随访，调查皮质骨轨迹（CBT）螺钉与传统椎弓根（TP）螺钉在 TLIF 中的临床和影像学结果。
很少有研究比较 CBT 螺钉与 TLIF 中的 TP 螺钉 5 年随访结果。
我们回顾了 2011 年至 2015 年间接受 CBT 螺钉（131 例）或 TP 螺钉（80 例）TLIF 手术的单节段腰椎退变性滑脱患者的结果数据。患者报告的临床结果数据包括 Oswestry 残疾指数评分和基线、术后 6 个月、1 年、2 年和 5 年时的腰背腿痛视觉模拟量表（VAS）评分。还测量了影像学融合率和继发于相邻节段疾病的手术发生率。
在 5 年的随访期间，CBT 组的腰痛 VAS 评分明显较低（分别为 P <0.0001）。术后 2 年，CBT 组的腿痛 VAS 评分明显较高（P =0.007）。术后 5 年，两组间腿痛 VAS 评分或 Oswestry 残疾指数评分无显著差异。影像学融合率（CBT 与 TP：95.5%与 95.9%；P =0.881）和术后 5 年内的不良事件无显著差异。术后 2 年，两组继发治疗相邻节段疾病的手术发生率有显著差异（CBT 与 TP：13.7%与 5.0%；P =0.044）。
我们的结果表明，在 5 年的随访中，与 TP 螺钉相比，在单节段腰椎退变性滑脱的情况下，CBT 螺钉用于 TLIF 是一种有效的治疗方法。然而，当使用 CBT 螺钉进行 TLIF 时，外科医生应考虑更高的继发手术率来治疗有症状的相邻节段疾病。
