间接减压-腰椎外侧椎间融合术中外侧单一体位下静态和可扩张椎间融合器的早期影像学评估

Early Radiological Assessment of Static and Expandable Cages in Lateral Single Position for Indirect Decompression- Lateral Lumbar Interbody Fusion.

作者信息

Hiyama Akihiko, Katoh Hiroyuki, Sakai Daisuke, Sato Masato, Watanabe Masahiko

机构信息

Department of Orthopaedic Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan.

Department of Orthopaedic Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan.

出版信息

World Neurosurg. 2023 Oct;178:e453-e464. doi: 10.1016/j.wneu.2023.07.097. Epub 2023 Jul 26.

Abstract

OBJECTIVE

This study aimed to compare the postoperative alignment of static and expandable cages in lateral single-position (LSP) for indirect decompression in lateral lumbar interbody fusion (LLIF).

METHODS

We included sixty-seven patients who underwent LSP-LLIF for lumbar degenerative disease. We performed radiological assessments preoperatively and two weeks postoperatively using computed tomography and magnetic resonance imaging. We divided the patients into the expandable cage group (23 patients) and the static cage group (44 patients). We measured disc height (DH), segmental lordosis (SL), and foraminal area (FA) from computed tomography images and the area of the dural sac from magnetic resonance imaging. We recorded surgical outcomes and complications.

RESULTS

Both static and expandable cages demonstrated improvements in DH, SL, FA, and dural sac expansion. However, we found no statistically significant differences in the average change in DH (4.4 ± 2.1 mm vs. 4.2 ± 1.8 mm, P = 0.685), the average change in SL (1.0 ± 4.4° vs. 1.9 ± 3.6°, P = 0.310), or FA change (32.5 ± 31.7 mm vs. 34.9 ± 29.5 mm, P = 0.966) between the expandable and static cage groups. We also found no statistically significant difference in dural sac enlargement between the two groups. We observed no significant differences in operation time, estimated blood loss, or length of hospital stay between the two groups. No severe adverse events or additional surgeries were reported.

CONCLUSIONS

In LSP-LLIF without facet joint resection or other posterior techniques, static and expandable cages showed comparable effectiveness in achieving increased DH, SL, FA, and indirect decompression.

摘要

目的

本研究旨在比较静态椎间融合器和可扩张椎间融合器在腰椎侧方椎间融合术(LLIF)间接减压的侧方单节段(LSP)手术中的术后对线情况。

方法

我们纳入了67例行LSP-LLIF治疗腰椎退行性疾病的患者。术前及术后两周使用计算机断层扫描(CT)和磁共振成像(MRI)进行影像学评估。将患者分为可扩张椎间融合器组(23例)和静态椎间融合器组(44例)。从CT图像测量椎间盘高度(DH)、节段性前凸(SL)和椎间孔面积(FA),从MRI测量硬脊膜囊面积。记录手术结果和并发症。

结果

静态和可扩张椎间融合器均显示DH、SL、FA和硬脊膜囊扩张有所改善。然而,我们发现可扩张椎间融合器组和静态椎间融合器组之间在DH的平均变化(4.4±2.1mm对4.2±1.8mm,P = 0.685)、SL的平均变化(1.0±4.4°对1.9±3.6°,P = 0.310)或FA变化(32.5±31.7mm对34.9±29.5mm,P = 0.966)方面无统计学显著差异。两组之间在硬脊膜囊扩大方面也无统计学显著差异。两组在手术时间、估计失血量或住院时间方面未观察到显著差异。未报告严重不良事件或额外手术。

结论

在不进行小关节切除或其他后路技术的LSP-LLIF中,静态和可扩张椎间融合器在实现DH增加、SL增加、FA增加和间接减压方面显示出相当的效果。

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