Hospital for Special Surgery, New York, NY.
Weill Cornell Medical College, New York, NY.
Spine (Phila Pa 1976). 2023 Dec 1;48(23):1670-1678. doi: 10.1097/BRS.0000000000004619. Epub 2023 Mar 13.
Retrospective review of prospectively collected multisurgeon data.
Examine the rate, clinical impact, and predictors of subsidence after expandable minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) cage.
Expandable cage technology has been adopted in MI-TLIF to reduce the risks and optimize outcomes. Although subsidence is of particular concern when using expandable technology as the force required to expand the cage can weaken the endplates, its rates, predictors, and outcomes lack evidence.
Patients who underwent 1 or 2-level MI-TLIF using expandable cages for degenerative lumbar conditions and had a follow-up of >1 year were included. Preoperative and immediate, early, and late postoperative radiographs were reviewed. Subsidence was determined if the average anterior/posterior disc height decreased by >25% compared with the immediate postoperative value. Patient-reported outcomes were collected and analyzed for differences at the early (<6 mo) and late (>6 mo) time points. Fusion was assessed by 1-year postoperative computed tomography.
One hundred forty-eight patients were included (mean age, 61 yr, 86% 1-level, 14% 2-level). Twenty-two (14.9%) demonstrated subsidence. Although statistically not significant, patients with subsidence were older, had lower bone mineral density, and had higher body mass index and comorbidity burden. Operative time was significantly higher ( P = 0.02) and implant width was lower ( P < 0.01) for subsided patients. Visual analog scale-leg was significantly lower for subsided patients compared with nonsubsided patients at a >6 months time point. Long-term (>6 mo) patient-acceptable symptom state achievement rate was lower for subsided patients (53% vs . 77%), although statistically not significant ( P = 0.065). No differences existed in complication, reoperation, or fusion rates.
Of the patients, 14.9% experienced subsidence predicted by narrower implants. Although subsidence did not have a significant impact on most patient-reported outcome measures and complication, reoperation, or fusion rates, patients had lower visual analog scale-leg and patient-acceptable symptom state achievement rates at the >6-month time point.
Level 4.
前瞻性收集多外科医生数据的回顾性研究。
检查可扩张微创经椎间孔腰椎体间融合术（MI-TLIF） cage 后沉降的发生率、临床影响和预测因素。
可扩张 cage 技术已应用于 MI-TLIF 中，以降低风险并优化结果。尽管在使用可扩张技术时，沉降特别令人关注，因为扩大 cage 所需的力会削弱终板，但沉降的发生率、预测因素和结果缺乏证据。
纳入接受 1 或 2 级 MI-TLIF 治疗退行性腰椎疾病且随访时间>1 年的患者。对术前、即刻、早期和晚期术后 X 线片进行了回顾。如果平均前/后椎间盘高度与即刻术后值相比下降>25%，则确定为沉降。收集患者报告的结果，并在早期（<6 个月）和晚期（>6 个月）时间点分析差异。通过术后 1 年的计算机断层扫描评估融合情况。
共纳入 148 例患者（平均年龄 61 岁，86%为 1 级，14%为 2 级）。22 例（14.9%）出现沉降。尽管统计学上无显著差异，但沉降患者年龄较大，骨密度较低，体重指数和合并症负担较高。沉降患者的手术时间显著延长（P=0.02），植入物宽度显著降低（P<0.01）。与非沉降患者相比，沉降患者在>6 个月时的视觉模拟量表-腿部评分显著降低。沉降患者的长期（>6 个月）患者可接受症状状态达标率较低（53%对 77%），尽管统计学上无显著差异（P=0.065）。在并发症、再次手术或融合率方面无差异。
在这些患者中，14.9%的患者出现了由植入物较窄引起的沉降，尽管沉降对大多数患者报告的结果测量以及并发症、再次手术或融合率没有显著影响，但在>6 个月时，患者的视觉模拟量表-腿部评分和患者可接受的症状状态达标率较低。
4 级。
