Montanari Sara, Griffoni Cristiana, Cristofolini Luca, Girolami Marco, Gasbarrini Alessandro, Barbanti Bròdano Giovanni
Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum - Università di Bologna, Bologna, Italy.
Spine Surgery Department, IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy.
Global Spine J. 2025 Jan;15(1):184-195. doi: 10.1177/21925682231195954. Epub 2023 Aug 10.
Retrospective cohort study.
This study aimed to investigate the failure of the caudal end of lumbar posterior fixation in terms of pre-operative and post-operative spinopelvic parameters, correction performed, demographic and clinical data.
The lumbar, thoraco-lumbar and lumbo-sacral posterior fixations performed with pedicle screws and rods in 2017-2019 were retrospectively analyzed. As 81% failures occurred within 4 years, an observational period of 4 years was chosen. The revision surgeries due to the failure in the caudal end were collected in the junctional group. Fixations which have not failed were gathered in the control group. The main spinopelvic parameters were measured for each patient on standing lateral radiographs with the software Surgimap. Demographic and clinical data were extracted for both groups.
Among the 457 patients who met the inclusion criteria, the junctional group included 101 patients, who required a revision surgery. The control group collected 356 primary fixations. The two most common causes of revision surgeries were screws pullout (57 cases) and rod breakage (53 cases). SVA, PT, LL, PI-LL and TPA differed significantly between the two groups ( = .021 for LL, < .0001 for all the others). The interaction between the two groups and the pre-operative and post-operative conditions was significant for PT, SS, LL, TK, PI-LL and TPA ( < .005). Sex and BMI did not affect the failure onset.
Mechanical failure is more likely to occur in patients older than 40 years with a thoraco-lumbar fixation where PT, PI-LL and TPA were not properly restored.
回顾性队列研究。
本研究旨在根据术前和术后脊柱骨盆参数、进行的矫正、人口统计学和临床数据，调查腰椎后路固定术尾端的失败情况。
回顾性分析2017年至2019年采用椎弓根螺钉和棒进行的腰椎、胸腰段和腰骶段后路固定术。由于81%的失败发生在4年内，因此选择4年的观察期。将因尾端失败而进行翻修手术的患者纳入连接组。未发生失败的固定术患者纳入对照组。使用Surgimap软件在站立位侧位X线片上测量每位患者的主要脊柱骨盆参数。提取两组的人口统计学和临床数据。
在符合纳入标准的457例患者中，连接组包括101例需要翻修手术的患者。对照组收集了356例初次固定术患者。翻修手术最常见的两个原因是螺钉拔出（57例）和棒断裂（53例）。两组之间的矢状面垂直轴（SVA）、骨盆倾斜角（PT）、腰椎前凸（LL）、骨盆入射角与腰椎前凸角差值（PI-LL）和胸椎后凸角（TPA）存在显著差异（LL为P = 0.021，其他均为P < 0.0001）。两组与术前和术后情况之间的交互作用在PT、骶骨斜率（SS）、LL、胸椎后凸（TK）、PI-LL和TPA方面具有显著性（P < 0.005）。性别和体重指数不影响失败的发生。
在胸腰段固定且PT、PI-LL和TPA未得到妥善恢复的40岁以上患者中，机械性失败更易发生。
