Sim David Shaoen, Kasivishvanaath Ayyadarshan, Jiang Lei, Cheong Soh Reuben Chee, Ling Zhixing Marcus
Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore.
Int J Spine Surg. 2023 Aug;17(4):520-525. doi: 10.14444/8472. Epub 2023 Apr 19.
This study investigated 1-year clinical and radiological outcomes of biplanar expandable (BE) cages following transforaminal lumbar interbody fusion (TLIF) in an Asian population.
A retrospective review was conducted of all consecutive patients who underwent TLIF with BE cages performed by 2 fellowship-trained spine surgeons from 2020 to 2021. Inclusion criteria included open or minimally invasive (MIS) TLIF, of up to 3 spinal segments, performed for treatment of degenerative disc disease, spondylolisthesis, or spinal stenosis. Patient-reported outcomes, including visual analog score (VAS) for back and lower limb pain, Oswestry Disability Index (ODI) and North American Spine Society neurogenic symptom score (NSS), and various radiographic parameters, were evaluated.
A total of 23 patients underwent TLIF with BE cages with a follow-up duration of 1.25 years. Of those patients, 7 (30%) underwent 1-level TLIF, 12 (52%) underwent 2-level TLIF, and 4 (18%) underwent 3-level TLIF, with a total of 43 spinal segments fused. Four patients (17%) underwent MIS TLIF while 19 patients (83%) underwent open TLIF. VAS for back pain scores improved by 4.8 ± 3.4 ( < 0.001) from 6.5 ± 2.6 to 1.7 ± 2.2; VAS for lower limb pain scores improved by 5.2 ± 3.8 ( < 0.001) from 5.7 ± 3.4 to 0.5 ± 1.6; ODI scores improved by 29.0 ± 18.1 ( < 0.001) from 49.4 ± 15.1 to 20.4 ± 14.2; and NSS scores improved by 36.8 ± 22.1 ( < 0.001) from 53.3 ± 21.1 to 16.5 ± 19.8. Significant improvements in radiological parameters included increase in anterior disc height, posterior disc height, foraminal height, segmental lordosis, and lumbar lordosis. There were no implant-related complications, cage subsidence, cage migration, or revision surgery at 1 year.
TLIF performed with BE cages led to significantly improved patient-reported outcomes and radiographic parameters at 1 year and is safe for use in Asians.
The results of this study support the effectiveness and safety of TLIF with biplanar expandable cages.
本研究调查了亚洲人群经椎间孔腰椎椎间融合术（TLIF）后使用双平面可扩张（BE）椎间融合器的1年临床和影像学结果。
对2020年至2021年由2名接受过专科培训的脊柱外科医生进行的所有连续接受BE椎间融合器TLIF手术的患者进行回顾性研究。纳入标准包括开放或微创（MIS）TLIF，手术节段最多为3个，用于治疗椎间盘退变、椎体滑脱或椎管狭窄。评估患者报告的结果，包括背部和下肢疼痛的视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）和北美脊柱协会神经源性症状评分（NSS），以及各种影像学参数。
共有23例患者接受了BE椎间融合器TLIF手术，随访时间为1.25年。其中，7例（30%）接受了单节段TLIF，12例（52%）接受了双节段TLIF，4例（18%）接受了三节段TLIF，共融合43个脊柱节段。4例患者（17%）接受了MIS TLIF，19例患者（83%）接受了开放TLIF。背部疼痛VAS评分从6.5±2.6显著改善至1.7±2.2，改善了4.8±3.4（P<0.001）；下肢疼痛VAS评分从5.7±3.4显著改善至0.5±1.6，改善了5.2±3.8（P<0.001）；ODI评分从49.4±15.1显著改善至20.4±14.2，改善了29.0±18.1（P<0.001）；NSS评分从53.3±21.1显著改善至16.5±19.8，改善了36.8±22.1（P<0.001）。影像学参数的显著改善包括椎间盘前缘高度、后缘高度、椎间孔高度、节段性前凸和腰椎前凸增加。1年时无植入物相关并发症、椎间融合器下沉、椎间融合器移位或翻修手术。
使用BE椎间融合器进行的TLIF在1年时显著改善了患者报告的结果和影像学参数，对亚洲人使用是安全的。
本研究结果支持使用双平面可扩张椎间融合器进行TLIF的有效性和安全性。
