Fushimi Kazunari, Miyagawa Takaki, Iwai Chizuo, Nozawa Satoshi, Iinuma Nobuki, Tanaka Ryo, Shirai Goshi, Tanahashi Hiroyuki, Yokoi Tatsuo, Akiyama Haruhiko
Department of Orthopaedic Surgery, Spine Surgery Center, Gifu Prefectural General Medical Center, Gifu, Japan.
Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan.
Global Spine J. 2024 Sep;14(7):2031-2038. doi: 10.1177/21925682231165709. Epub 2023 Mar 21.
Clinical and basic study.
This study aimed to investigate whether transforaminal lumbar interbody fusion (TLIF) using 2 banana-shaped cages leads to good clinical outcomes.
First, we conducted a clinical study to compare outcomes among patients who underwent TLIF using different types or numbers of cages. Propensity matched patients in each group were reviewed. Thirty-four patients who underwent surgery with 2 bullet-shaped cages (group A), 34 with a banana-shaped cage (group B), and 34 with 2 banana-shaped cages (group C) were compared. Twelve months after the surgery, bony fusion and cage subsidence were evaluated.
The mean amount of cage subsidence was 14.9% in group A, 19.9% in group B, and 11.8% in group C. Subsidence in group B was significantly greater than that in group C ( < .01). Radiological bony fusion was not achieved in 2 cases in group B. Second, we performed a finite element model (FEM) analysis to determine the biomechanical stress of the vertebral endplate by comparing the single-banana cage construct with a double banana-shaped cage construct. FEM analysis showed that the maximum stress of the endplate in the single-cage model was 1.72-times greater than the maximum stress in the double-cage model. Furthermore, the maximal stress in the single-cage model was significantly higher than in the double-cage model during lumbar extension and side bending.
This study showed that TLIF with double banana-shaped cages led to good clinical outcomes with less cage subsidence, probably because of decreased mechanical stress on the vertebral endplate.
临床与基础研究。
本研究旨在探讨使用2个香蕉形椎间融合器的经椎间孔腰椎椎间融合术（TLIF）是否能带来良好的临床效果。
首先，我们进行了一项临床研究，比较接受不同类型或数量椎间融合器的TLIF患者的治疗效果。对每组倾向匹配的患者进行了评估。比较了34例行2个子弹形椎间融合器手术的患者（A组）、34例行1个香蕉形椎间融合器手术的患者（B组）和34例行2个香蕉形椎间融合器手术的患者（C组）。术后12个月，评估骨融合和椎间融合器下沉情况。
A组椎间融合器平均下沉量为14.9%，B组为19.9%，C组为11.8%。B组的下沉量显著大于C组（<0.01）。B组有2例未实现放射学骨融合。其次，我们进行了有限元模型（FEM）分析，通过比较单香蕉形椎间融合器结构和双香蕉形椎间融合器结构来确定椎体终板的生物力学应力。FEM分析表明，单椎间融合器模型中终板的最大应力比双椎间融合器模型中的最大应力大1.72倍。此外，在腰椎伸展和侧弯时，单椎间融合器模型中的最大应力显著高于双椎间融合器模型。
本研究表明，采用双香蕉形椎间融合器的TLIF能带来良好的临床效果，且椎间融合器下沉较少，这可能是由于椎体终板上的机械应力降低所致。
