Hagihara Shusuke, Ohta Hideki, Tanaka Jun, Shiokawa Teruaki, Kida Yoshikuni, Iguchi Yohei, Tatsumi Masato, Shibata Ryo, Tahara Kenichi, Shibata Tatsuya, Sanada Kyoichi, Ymamoto Takuaki
Department of Orthopeadics Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
Oita Orthopaedic Hospital, Oita, Japan.
Asian Spine J. 2023 Oct;17(5):818-825. doi: 10.31616/asj.2022.0453. Epub 2023 Oct 4.
This study adopted a retrospective cohort study design.
This study aimed to clarify the influence of diffuse idiopathic skeletal hyperostosis (DISH) on bone fusion after transforaminal lumbar interbody fusion (TLIF).
The negative effects of DISH on lumbar degenerative diseases have been reported, and DISH may be involved in the onset and severity of lumbar spinal canal stenosis. Patients with DISH have significantly more reoperations after posterior lumbar fusion, including TLIF. However, the effects of DISH on bone fusion after TLIF have not been reported.
The medical records of patients with intervertebral TLIF from 2012 to 2018 were retrospectively examined. The patients were divided into those with fusion and those with pseudoarthrosis, and the following data were compared: age, sex, DISH, diabetes mellitus, smoking, drinking, albumin levels, body mass index ≥30 kg/m2, and L5/S fixation. Statistical analyses were performed using regression models.
In this study, 180 patients (78.6%) had fusion and 49 patients (21.4%) had pseudoarthrosis. The number of patients with DISH was significantly higher in the pseudoarthrosis group than in the fusion group (36.7% and 21.7%, respectively; univariate p=0.031, multivariate p =0.019). No significant differences in age, sex, diabetes mellitus, smoking, drinking, albumin levels, body mass index ≥30 kg/m2, and L5/S fixation were observed between the two groups. The risk factors for bone fusion were statistically analyzed in 57 patients with DISH. DISH with a caudal end below Th11 was an independent risk factor for pseudoarthrosis (univariate p=0.011, multivariate p=0.033).
DISH is an independent risk factor for pseudoarthrosis after one intervertebral TLIF, and DISH with a caudal end below Th11 is associated with a higher risk of pseudoarthrosis than DISH without a caudal end below Th11.
本研究采用回顾性队列研究设计。
本研究旨在阐明弥漫性特发性骨肥厚（DISH）对经椎间孔腰椎椎间融合术（TLIF）后骨融合的影响。
已有报道称DISH对腰椎退行性疾病有负面影响，且DISH可能与腰椎管狭窄的发病及严重程度有关。DISH患者在包括TLIF在内的后路腰椎融合术后再次手术的情况明显更多。然而，DISH对TLIF术后骨融合的影响尚未见报道。
回顾性查阅2012年至2018年接受椎间TLIF患者的病历。将患者分为融合组和假关节形成组，并比较以下数据：年龄、性别、DISH、糖尿病、吸烟、饮酒、白蛋白水平、体重指数≥30kg/m²以及L5/S固定情况。使用回归模型进行统计分析。
本研究中，180例患者（78.6%）实现融合，49例患者（21.4%）出现假关节形成。假关节形成组中DISH患者数量显著高于融合组（分别为36.7%和21.7%；单因素p = 0.031，多因素p = 0.019）。两组在年龄、性别、糖尿病、吸烟、饮酒、白蛋白水平、体重指数≥30kg/m²以及L5/S固定情况方面未观察到显著差异。对57例DISH患者的骨融合危险因素进行了统计分析。尾端低于胸11的DISH是假关节形成的独立危险因素（单因素p = 0.011，多因素p = 0.033）。
DISH是单节段椎间TLIF术后假关节形成的独立危险因素，且尾端低于胸11的DISH比尾端不低于胸11的DISH发生假关节形成的风险更高。
