Division of Orthopedic Surgery Spine Program, Department of Surgery, University of Calgary, Calgary, Alberta, Canada.
Division of Orthopedic Surgery Spine Program, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
World Neurosurg. 2023 Jul;175:e1265-e1276. doi: 10.1016/j.wneu.2023.04.113. Epub 2023 May 3.
Lumbosacral pseudoarthrosis is a common complication following adult spine deformity (ASD) surgery. This study assessed the reoperation rate for L5-S1 pseudoarthrosis in the ASD population. Compared with transforaminal lumbar interbody fusions (TLIFs), we hypothesized that anterior lumbar interbody fusion (ALIF) would result in lower rates of L5-S1 pseudarthrosis.
This is a single center study with patient data retrieved from a prospective ASD database. The patients had a long-segment fusion, ALIF or TLIF at the L5-S1 level with a 2-year follow-up and were divided into 2 groups (TLIF and ALIF). The study's primary outcome was to assess the difference in the reoperation rate for clinical pseudoarthrosis between the TLIF and the ALIF groups. The secondary outcomes measured the radiological pseudoarthrosis rate and identified risks for L5-S1 pseudoarthrosis development.
A total of 100 patients were included; 49 patients (mean age, 62.9 years; 77.5% females) were in TLIF and 51 patients (mean age, 64.4 years; 70.6% females) were in the ALIF group. Baseline characteristics were similar in both groups. Thirteen (13%) patients with L5-S1 pseudoarthrosis required reoperation. Clinical pseudoarthrosis was higher in the TLIF group than in the ALIF group (12/49 vs. 1/51; P < 0.001). Univariate analysis demonstrated a higher risk of L5-S1 pseudoarthrosis with TLIF than ALIF (risk ratio, 12.4; 95% confidence interval: 1.68-92.4; P < 0.001). Multivariate analysis revealed 4.86 times the risk of L5-S1 clinical pseudoarthrosis with TLIF than with ALIF (risk ratio, 4.86; 95% confidence interval 0.57-47; P = 0.17), but this ratio did not reach statistical significance.
No difference in reoperation risk for L5-S1 pseudarthrosis was observed based on the method of IF. rhBMP-2 was noted as a significant predictor.
腰骶假关节是成人脊柱畸形（ASD）手术后的常见并发症。本研究评估了 ASD 人群中 L5-S1 假关节的再次手术率。与经椎间孔腰椎体间融合术（TLIF）相比，我们假设前路腰椎体间融合术（ALIF）会降低 L5-S1 假关节的发生率。
这是一项单中心研究，患者数据来自前瞻性 ASD 数据库。这些患者接受了长节段融合，L5-S1 水平行 ALIF 或 TLIF ，并随访 2 年，分为 2 组（TLIF 和 ALIF）。本研究的主要结局是评估 TLIF 和 ALIF 组之间临床假关节再手术率的差异。次要结局测量放射学假关节率，并确定 L5-S1 假关节发展的风险因素。
共纳入 100 例患者；49 例（平均年龄 62.9 岁；77.5%为女性）为 TLIF 组，51 例（平均年龄 64.4 岁；70.6%为女性）为 ALIF 组。两组基线特征相似。13 例（13%）L5-S1 假关节患者需要再次手术。TLIF 组的临床假关节发生率高于 ALIF 组（12/49 比 1/51；P<0.001）。单因素分析显示，TLIF 比 ALIF 发生 L5-S1 假关节的风险更高（风险比 12.4；95%置信区间：1.68-92.4；P<0.001）。多因素分析显示，TLIF 发生 L5-S1 临床假关节的风险是 ALIF 的 4.86 倍（风险比 4.86；95%置信区间 0.57-47；P=0.17），但这一比值未达到统计学意义。
根据 IF 方法，L5-S1 假关节再手术风险无差异。rhBMP-2 被认为是一个显著的预测因素。
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