Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York, NY.
New York Spine Institute, New York, NY.
Spine (Phila Pa 1976). 2024 Feb 1;49(3):174-180. doi: 10.1097/BRS.0000000000004648. Epub 2023 Mar 24.
Retrospective study.
Evaluate surgical characteristics and postoperative 2-year results of the PL approach to spinal fusion.
Prone-lateral(PL) single positioning has recently gained popularity in spine surgery due to lower blood loss and operative time but has yet to be examined for other notable outcomes, including realignment and patient-reported measures.
We included circumferential spine fusion patients with a minimum one-year follow-up. Patients were stratified into groups based on undergoing PL approach versus same-day staged (Staged). Mean comparison tests identified differences in baseline parameters. Multivariable logistic regression, controlling for age, levels fused, and Charlson Comorbidity Index were used to determine the influence of the approach on complication rates, radiographic and patient-reported outcomes up to two years.
One hundred twenty-two patients were included of which 72(59%) were same-day staged and 50(41%) were PL. PL patients were older with lower body mass index (both P <0.05). Patients undergoing PL procedures had lower estimated blood loss and operative time (both P <0.001), along with fewer osteotomies (63% vs. 91%, P <0.001). This translated to a shorter length of stay (3.8 d vs. 4.9, P =0.041). PL procedures demonstrated better correction in both PT (4.0 vs. -0.2, P =0.033 and pelvic incidence and lumbar lordosis (-3.7 vs. 3.1, P =0.012). PL procedures were more likely to improve in GAP relative pelvic version (OR: 2.3, [1.5-8.8]; P =0.003]. PL patients suffered lesser complications during the perioperative period and greater improvement in NRS-Back (-6.0 vs. -3.3, P =0.031), with less reoperations (0.0% vs. 4.8%, P =0.040) by two years.
Patients undergoing PL single-position procedures received less invasive procedures with better correction of pelvic compensation, as well as earlier discharge. The prone lateral cohort also demonstrated greater clinical improvement and a lower rate of reoperations by two years following spinal corrective surgery.
Level-III.
回顾性研究。
评估脊柱融合后路经椎间孔椎体间融合术（PL 入路）的手术特点和术后 2 年的结果。
由于出血量和手术时间减少，俯卧位-侧位（PL）单体位近来在脊柱外科中越来越受欢迎，但尚未对包括矫形和患者报告的结果在内的其他显著结果进行检查。
我们纳入了至少随访 1 年的全脊柱融合患者。根据行 PL 入路与同期分阶段（分期）手术将患者分为两组。采用均值比较检验比较基线参数差异。采用多变量逻辑回归，控制年龄、融合节段和 Charlson 合并症指数，确定入路对并发症发生率、影像学和患者报告的结果的影响，随访时间长达 2 年。
共纳入 122 例患者，其中 72 例（59%）为同期分期手术，50 例（41%）为 PL 入路手术。PL 组患者年龄较大，体重指数较低（均 P <0.05）。行 PL 手术的患者失血量和手术时间均较少（均 P <0.001），且截骨更少（63%比 91%，P <0.001）。这导致住院时间缩短（3.8 d 比 4.9 d，P =0.041）。PL 组在 PT（4.0 比 -0.2，P =0.033）和骨盆入射角与腰椎前凸角（-3.7 比 3.1，P =0.012）方面的矫正效果更好。PL 组在 GAP 相对骨盆倾斜角方面的改善更有可能（OR：2.3，[1.5-8.8]；P =0.003）。PL 组患者在围手术期并发症较少，NRS-Back 评分改善更明显（-6.0 比 -3.3，P =0.031），术后 2 年再手术率较低（0.0%比 4.8%，P =0.040）。
行 PL 单体位手术的患者接受了侵袭性较小的手术，骨盆代偿性矫正更好，出院更早。在脊柱矫形手术后 2 年，俯卧位侧位组的患者表现出更大的临床改善和更低的再手术率。
III 级。
