Ledesma Jonathan A, Ottaway Jesse C, Lambrechts Mark J, Dees Azra, Thomas Terence L, Kurd Mark F, Radcliff Kris E, Anderson David G
Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA.
Neurospine. 2023 Jun;20(2):487-497. doi: 10.14245/ns.2244870.435. Epub 2023 Jun 30.
To compare the early radiographic and clinical outcomes of expandable uniplanar versus biplanar interbody cages used for single-level minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF).
A retrospective review of 1-level MIS-TLIFs performed with uniplanar and biplanar polyetheretherketone cages was performed. Radiographic measurements were performed on radiographs taken preoperatively, at 6-week follow-up, and 1-year follow-up. Oswestry Disability Index (ODI) and visual analogue scale (VAS) for back and leg at 3-month and 1-year follow-up.
A total of 93 patients (41 uniplanar, 52 biplanar) were included. Both cage types provided significant postoperative improvements in anterior disc height, posterior disc height, and segmental lordosis at 1 year. No significant differences in cage subsidence rates were found between uniplanar (21.9%) and biplanar devices (32.7%) at 6 weeks (odds ratio, 2.015; 95% confidence interval, 0.651-6.235; p = 0.249) with no additional instances of subsidence at 1 year. No significant differences in the magnitude of improvements based on ODI, VAS back, or VAS leg at 3-month or 1-year follow-up between groups and the proportion of patients achieving the minimal clinically important difference in ODI, VAS back, or VAS leg at 1 year were not statistically significantly different (p > 0.05). Finally, there were no significant differences in complication rates (p = 0.283), 90-day readmission rates (p = 1.00), revision surgical procedures (p = 0.423), or fusion rates at 1 year (p = 0.457) between groups.
Biplanar and uniplanar expandable cages offer a safe and effective means of improving anterior disc height, posterior disc height, segmental lordosis, and patient-reported outcome measures at 1 year postoperatively. No significant differences in radiographic outcomes, subsidence rates, mean subsidence distance, 1-year patient-reported outcomes, and postoperative complications were noted between groups.
比较用于单节段微创经椎间孔腰椎椎间融合术（MIS-TLIF）的可扩张单平面与双平面椎间融合器的早期影像学和临床疗效。
对采用单平面和双平面聚醚醚酮融合器进行的单节段MIS-TLIF手术进行回顾性研究。在术前、术后6周和1年随访时拍摄的X线片上进行影像学测量。在3个月和1年随访时评估Oswestry功能障碍指数（ODI）以及背部和腿部的视觉模拟评分（VAS）。
共纳入93例患者（单平面组41例，双平面组52例）。两种类型的融合器在术后1年时均使前间隙高度、后间隙高度和节段性前凸有显著改善。单平面融合器（21.9%）和双平面融合器（32.7%）在术后6周时的融合器下沉率无显著差异（优势比，2.015；95%置信区间，0.651 - 6.235；p = 0.249），且在1年时无额外下沉情况。两组在3个月或1年随访时基于ODI、VAS背部或VAS腿部的改善幅度以及在1年时达到ODI、VAS背部或VAS腿部最小临床重要差异的患者比例均无统计学显著差异（p > 0.05）。最后，两组在并发症发生率（p = 0.283）、90天再入院率（p = 1.00）、翻修手术率（p = 0.423）或1年融合率（p = 0.457）方面均无显著差异。
双平面和单平面可扩张融合器为术后1年改善前间隙高度、后间隙高度、节段性前凸以及患者报告的疗效指标提供了一种安全有效的方法。两组在影像学结果、下沉率、平均下沉距离、1年患者报告的疗效以及术后并发症方面均未发现显著差异。
