经Kambin三角入路不进行椎板切除使用可扩张钛笼行腰椎椎间融合术的两年临床及影像学结果
Two-Year Clinical and Radiographic Outcomes for Percutaneous Lumbar Interbody Fusion With an Expandable Titanium Cage Through Kambin's Triangle Without Facetectomy.
作者信息
Tabarestani Troy Q, Wang Timothy Y, Sykes David A W, Mehta Vikram A, Yang Lexie Z, Chow Shein-Chung, Shaffrey Christopher I, Wiggins Walter F, Chi John H, Abd-El-Barr Muhammad M
机构信息
Duke University School of Medicine, Duke University Hospital, Durham, NC, USA
Department of Neurosurgery, Duke University Hospital, Durham, NC, USA.
出版信息
Int J Spine Surg. 2023 Dec 26;17(6):760-770. doi: 10.14444/8540.
BACKGROUND
There has been heightened interest in performing percutaneous lumbar interbody fusions (percLIFs) through Kambin's triangle, an anatomic corridor allowing entrance into the disc space. However, due to its novelty, there are limited data regarding the long-term benefits of this procedure. Our objective was to determine the long-term efficacy and durability of the percutaneous insertion of an expandable titanium cage through Kambin's triangle without facetectomy.
METHODS
A retrospective review of patients undergoing percLIF via Kambin's triangle using an expandable titanium cage was performed. Demographics, visual analog scale (VAS) scores, Oswestry Disability Index (ODI), radiographic measurements, perioperative variables, and complications were recorded. VAS, ODI, and radiographic measurements were compared with baseline using the generalized estimating equations assuming normally distributed data. Fusion was assessed with computed tomography (CT) at 1 and 2 years after the procedure.
RESULTS
A total of 49 patients were included. Spondylolisthesis, lumbar lordosis (LL), sacral slope, pelvic tilt, and anterior/posterior disc space height were all significantly improved postoperatively at each time point of 3, 6, 12, and 24 months ( 0.001). Pelvic incidence-LL mismatch decreased significantly at each follow-up ( 0.001) with a mean reduction of 4° by 24 months. VAS back scores reduced by >2 points at the 6, 12, and 24 month follow-ups. ODI scores reduced by >15 points at the 12- and 24-month follow-ups. Of the patients who had 1- and 2-year CT images, fusion rates at those time points were 94.4% (17/18) and 87.5% (7/8), respectively. The mean annual rate of surgically significant adjacent segment disease was 2.74% through an average follow-up of 2.74 years.
CONCLUSION
These results highlight that percLIF, a procedure done without an endoscope or facetectomy, can be performed using an expandable titanium cage through Kambin's triangle with excellent radiographic and clinical results.
CLINICAL RELEVANCE
percLIF via Kambin's triangle is a safe and succesful procedure with long-term improvements in both clinical and radiographic outcomes.
背景
通过坎宾三角区进行经皮腰椎椎间融合术（percLIF）引发了越来越高的关注，坎宾三角区是一个可进入椎间盘间隙的解剖通道。然而，由于其新颖性，关于该手术长期益处的数据有限。我们的目的是确定经坎宾三角区在不进行小关节切除术的情况下经皮插入可扩张钛笼的长期疗效和耐用性。
方法
对通过坎宾三角区使用可扩张钛笼进行percLIF的患者进行回顾性研究。记录人口统计学数据、视觉模拟量表（VAS）评分、奥斯维斯特里功能障碍指数（ODI）、影像学测量结果、围手术期变量和并发症。使用广义估计方程，假设数据呈正态分布，将VAS、ODI和影像学测量结果与基线进行比较。在术后1年和2年通过计算机断层扫描（CT）评估融合情况。
结果
共纳入49例患者。在术后3、6、12和24个月的每个时间点，腰椎滑脱、腰椎前凸（LL）、骶骨倾斜度、骨盆倾斜度以及椎间盘前后间隙高度均有显著改善（P<0.001）。在每次随访时，骨盆入射角-LL不匹配均显著降低（P<0.001），到24个月时平均降低4°。在6、12和24个月随访时，VAS背部疼痛评分降低超过2分。在12个月和24个月随访时，ODI评分降低超过15分。在有1年和2年CT图像的患者中，这些时间点的融合率分别为94.4%（17/18）和87.5%（7/8）。通过平均2.74年的随访，具有手术意义的相邻节段疾病的年均发生率为2.74%。
结论
这些结果表明，不使用内窥镜或进行小关节切除术的percLIF，可以通过坎宾三角区使用可扩张钛笼进行，具有出色的影像学和临床效果。
临床意义
通过坎宾三角区进行percLIF是一种安全且成功的手术，在临床和影像学结果方面均有长期改善。
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