Coflex 层间稳定在封顶手术中对局部和整体脊柱矢状位平衡的影响。

PURPOSE: To investigate the effect of interlaminar Coflex stabilization (ICS) at various segments in the topping-off procedure on local and global spinal sagittal alignment. METHODS: Eighty-nine consecutive patients with degenerative lumbar spinal stenosis (DLSS) who underwent ICS and transforaminal lumbar interbody fusion (TLIF) were retrospectively reviewed. They were divided into Group A (L4-L5 ICS + L5-S1 TLIF), Group B (L3-L4 ICS + L4-S1 TLIF), and Group C (L2-L3 ICS + L3-S1 TLIF) according to their fusion levels. The measured local sagittal parameters included the implanted segmental angle (ISA), intervertebral disc angle (IDA), intervertebral foreman height (IFH), and disc height. The assessed global sagittal parameters included thoracic kyphosis, lumbar lordosis (LL), the fused segment angle (FSA), the sacral slope, the pelvic tilt, pelvic incidence, and the sagittal vertical axis. The Oswestry Disability Index (ODI) and visual analog scales (VAS) were recorded to evaluate the clinical outcomes. RESULTS: Regarding the local alignment parameters, the ISA and IDA decreased immediately after surgery in Groups A and B, followed by an increase at the last follow-up (all, P < 0.05). Conversely, the IFH of Groups A and B first increased after surgery and then decreased to approximately the original value (all, P < 0.05). No significant differences were evident between the local sagittal parameters at different time points in Group C. Regarding the global sagittal profiles, the LL and FSA exhibited a significant postoperative increase (both at P < 0.05) in all the groups. All three groups displayed significant improvements in the ODI, VAS-back pain, and VAS-leg pain. Furthermore, 4.5% (4/89) of the patients exhibited radiographic adjacent segment degeneration (ASD) at the last follow-up. CONCLUSION: ICS during topping-off surgery led to a temporary loss of local lordosis, especially in the lower lumbar segment, while the intervertebral space realigned after middle-term follow-up. The topping-off procedure with ICS is a feasible and promising surgical option of DLSS since it reduces fusion levels and prevents ASD development.

目的：研究在加层手术中在不同节段行椎板间 Coflex 稳定术（ICS）对局部和整体脊柱矢状位平衡的影响。

方法：回顾性分析 89 例退行性腰椎管狭窄症（DLSS）患者，这些患者均接受 ICS 联合经椎间孔腰椎体间融合术（TLIF）治疗。根据融合节段，将患者分为 A 组（L4-L5 ICS+L5-S1 TLIF）、B 组（L3-L4 ICS+L4-S1 TLIF）和 C 组（L2-L3 ICS+L3-S1 TLIF）。测量局部矢状位参数包括植入节段角（ISA）、椎间盘角（IDA）、椎间孔高度（IFH）和椎间盘高度。评估的整体矢状位参数包括胸椎后凸角、腰椎前凸角（LL）、融合节段角（FSA）、骶骨倾斜角、骨盆倾斜角、骨盆入射角和矢状垂直轴。记录 Oswestry 功能障碍指数（ODI）和视觉模拟评分（VAS）以评估临床结果。

结果：在局部排列参数方面，A 组和 B 组的 ISA 和 IDA 在术后即刻下降，随后在末次随访时增加（均 P<0.05）。相反，A 组和 B 组的 IFH 术后先增加，然后降至接近原始值（均 P<0.05）。C 组不同时间点的局部矢状位参数无显著差异。在整体矢状位方面，所有三组的 LL 和 FSA 术后均显著增加（均 P<0.05）。三组患者的 ODI、VAS-腰痛和 VAS-腿痛均显著改善。此外，末次随访时，4.5%（4/89）的患者出现影像学相邻节段退变（ASD）。

结论：加层手术中行 ICS 可导致局部腰椎前凸暂时丧失，尤其是在下腰椎段，而在中期随访后椎间间隙重新排列。ICS 加层手术是一种可行且有前途的治疗退行性腰椎管狭窄症的手术方法，因为它可以减少融合节段并防止 ASD 的发展。