微创经椎间孔腰椎椎间融合术后节段性和整体腰椎前凸的预测因素：连续病例系列研究
Predictors of Postoperative Segmental and Overall Lumbar Lordosis in Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Consecutive Case Series.
作者信息
Zhang Justin K, Greenberg Jacob K, Javeed Saad, Benedict Braeden, Botterbush Kathleen S, Dibble Christopher F, Khalifeh Jawad M, Brehm Samuel, Jain Deeptee, Dorward Ian, Santiago Paul, Molina Camilo, Pennicooke Brenton H, Ray Wilson Z
机构信息
Department of Neurological Surgery, Washington University, St. Louis, MO, USA.
Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA.
出版信息
Global Spine J. 2025 Mar;15(2):425-437. doi: 10.1177/21925682231193610. Epub 2023 Jul 31.
STUDY DESIGN
Retrospective Case-Series.
OBJECTIVES
Due to heterogeneity in previous studies, the effect of MI-TLIF on postoperative segmental lordosis (SL) and lumbar lordosis (LL) remains unclear. Therefore, we aim to identify radiographic factors associated with lordosis after surgery in a homogenous series of MI-TLIF patients.
METHODS
A single-center retrospective review identified consecutive patients who underwent single-level MI-TLIF for grade 1 degenerative spondylolisthesis from 2015-2020. All surgeries underwent unilateral facetectomies and a contralateral facet release with expandable interbody cages. PROs included the ODI and NRS-BP for low-back pain. Radiographic measures included SL, disc height, percent spondylolisthesis, cage positioning, LL, PI-LL mismatch, sacral-slope, and pelvic-tilt. Surgeries were considered "lordosing" if the change in postoperative SL was ≥ +4° and "kyphosing" if ≤ -4°. Predictors of change in SL/LL were evaluated using Pearson's correlation and multivariable regression.
RESULTS
A total of 73 patients with an average follow-up of 22.5 (range 12-61) months were included. Patients experienced significant improvements in ODI (29% ± 22% improvement, < .001) and NRS-BP (3.3 ± 3 point improvement, < .001). There was a significant increase in mean SL (Δ3.43° ± 4.37°, < .001) while LL (Δ0.17° ± 6.98°, > .05) remained stable. Thirty-eight (52%) patients experienced lordosing MI-TLIFs, compared to 4 (5%) kyphosing and 31 (43%) neutral MI-TLIFs. A lower preoperative SL and more anterior cage placement were associated with the greatest improvement in SL (β = -.45° = .001, β = 15.06° < .001, respectively).
CONCLUSIONS
In our series, the majority of patients experienced lordosing or neutral MI-TLIFs (n = 69, 95%). Preoperative radiographic alignment and anterior cage placement were significantly associated with target SL following MI-TLIF.
研究设计
回顾性病例系列研究。
目的
由于既往研究存在异质性，微创经椎间孔腰椎椎间融合术（MI-TLIF）对术后节段性前凸（SL）和腰椎前凸（LL）的影响仍不明确。因此，我们旨在确定一组同质的MI-TLIF患者术后与前凸相关的影像学因素。
方法
一项单中心回顾性研究纳入了2015年至2020年因1度退行性腰椎滑脱接受单节段MI-TLIF手术的连续患者。所有手术均行单侧小关节突切除术及对侧小关节松解并植入可扩张椎间融合器。患者报告结局（PROs）包括腰椎功能障碍指数（ODI）和下腰痛数字等级量表（NRS-BP）。影像学测量指标包括SL、椎间盘高度、腰椎滑脱百分比、椎间融合器位置、LL、骨盆入射角与腰椎前凸不匹配度、骶骨倾斜度和骨盆倾斜度。若术后SL变化≥ +4°，手术视为“前凸增加”；若≤ -4°，则视为“后凸增加”。使用Pearson相关性分析和多变量回归评估SL/LL变化的预测因素。
结果
共纳入73例患者，平均随访22.5个月（范围12 - 61个月）。患者的ODI显著改善（改善29% ± 22%，P <.001），NRS-BP也显著改善（改善3.3 ± 3分，P <.001）。平均SL显著增加（Δ3.43° ± 4.37°，P <.001），而LL保持稳定（Δ0.17° ± 6.98°，P >.05）。38例（52%）患者经历了前凸增加的MI-TLIF手术，4例（5%）为后凸增加，31例（43%）为无明显前凸或后凸变化的手术。术前较低的SL和椎间融合器更靠前的放置位置与SL的最大改善相关（β = -.45°，P =.001；β = 15.06°，P <.001）。
结论
在我们的研究系列中，大多数患者经历了前凸增加或无明显前凸或后凸变化的MI-TLIF手术（n = 69，95%）。术前影像学对线和椎间融合器的前位放置与MI-TLIF术后的目标SL显著相关。
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