Wang Da Wei, Wang Hua Dong, Li Li, Yin Xin, Huang Wei, Guo Ji Dong, Yang Ya Feng, Liu Yi Hao, Zheng Yang
Department of Spine Surgery, the Fourth Medical Center, Chinese PLA General Hospital, Beijing 100048, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2023 Oct 18;55(5):899-909. doi: 10.19723/j.issn.1671-167X.2023.05.019.
To compare and analyze the feasibility of autologous facet joint bone block as an alternative to polyetheretherketone (PEEK) cage in lumbar intervertebral fusion surgery for patients with osteoporosis.
From December 2018 to June 2021, the case data of patients with osteoporosis (T value ≤ -2.5 on dual energy X-ray bone density) who underwent posterior lumbar interbody fusion in the Fourth Medical Center, Chinese PLA General Hospital were retrospectively reviewed. All the cases were followed up for no less than 12 months and were divided into two groups according to the differences of interbody fusion materials: the autologous facet joint bone block group (autogenous bone group) and the PEEK cage group (PEEK group). The general data [such as age, gender, body mass index (BMI), primary diagnosis, distribution of fusion segments, bone mineral density of lumbar (BMD), incidence of preoperative complications], the perioperative data (such as duration of operation, intraoperative blood loss, postoperative drainage, perioperative allogeneic blood transfusion rate), and the incidence of postoperative complications were compared between the two groups. Imaging parameters (disc height, lumbar lordosis angle, segment lordosis angle, segmental lordosis angle, disc height improvement rate, and fusion rate) and lumbar functional scores [visual analogue scale (VAS), Oswestry disability index (ODI), Japanese Orthopedics Association (JOA) score for lower back pain] were compared to evaluate the clinical efficacy between the kinds of intervertebral fusion materials 1 week, 3 months and 6 months postoperative and at the last follow-up.
A total of 118 patients were enrolled, including 68 cases in the autogenous bone group and 50 cases in the PEEK group, there were no statistical differences in age, gender, BMI, primary diagnosis, distribution of fusion segments, BMD, incidence of preoperative complications, duration of operation, intraoperative blood loss, postoperative drainage, perioperative allogeneic blood transfusion rate, incidence of postoperative complications, all the preoperative imaging parameters and all the lumbar function scores between the two groups (>0.05). Postoperative superficial surgical site infections occurred in 3 patients in the autogenous bone group and 2 patients in the PEEK group. At the last follow-up, 3 cases of intervertebral graft collapse occurred in the autogenous bone group and 5 cases in the PEEK group, 1 case of graft subsidence in the autogenous bone group and 1 case in the PEEK group. All the imaging parameters showed significant differences between postoperation and preoperation ( < 0.05), and all the imaging parameters showed significant differences between 1 week and 3 months postoperative in both groups ( < 0.05). The height, angle of fusion gap in the autogenous bone group were lower than those in the PEEK group 1 week postoperatively ( < 0.05), and the fusion gap height improvement rate in the autogenous bone group was lower than that in the PEEK group ( < 0.05). The cases in both groups started to show final fusion 3 months after surgery, and the fusion rate in the autogenous bone group was 75% 6 months postoperatively, which was significantly higher than the rate of 56% in the PEEK group ( < 0.05), and there was no statistically significant difference in the final fusion rate between the two groups (>0.05). The ODI, the postoperative VAS score was significantly lower than that in preoperation, while the postoperative JOA score was significantly higher than that in preoperation ( < 0.05). The ODI was lower while the JOA score was higher of the autogenous bone group than that of the PEEK group 6 months postoperatively ( < 0.05).
In osteoporosis patients, good interbody fusion rate and improvement of lumbar vertebral function can be obtained by using autologous facet joint bone block or PEEK cage, while the fusion rate and the improvement of lumbar function with autologous facet joint bone block are better than those with PEEK cage 6 months post-operatively. PEEK cage is superior to autologous facet joint bone block in intervertebral distraction and improvement of lumbar lordosis. Significant disc space subsidence occurred in osteoporotic patients within 3 months after lumbar interbody fusion, and the subsidence of PEEK cage was more obvious than that of autologous facet joint bone block.
比较并分析自体小关节骨块替代聚醚醚酮（PEEK）椎间融合器用于骨质疏松患者腰椎椎间融合手术的可行性。
回顾性分析2018年12月至2021年6月在中国人民解放军总医院第四医学中心接受后路腰椎椎间融合术的骨质疏松患者（双能X线骨密度T值≤-2.5）的病例资料。所有病例均随访不少于12个月，根据椎间融合材料的不同分为两组：自体小关节骨块组（自体骨组）和PEEK椎间融合器组（PEEK组）。比较两组患者的一般资料[如年龄、性别、体重指数（BMI）、初步诊断、融合节段分布、腰椎骨密度（BMD）、术前并发症发生率]、围手术期资料（如手术时间、术中出血量、术后引流量、围手术期异体输血率）以及术后并发症发生率。比较影像学参数（椎间盘高度、腰椎前凸角、节段前凸角、节段性前凸角、椎间盘高度改善率和融合率）和腰椎功能评分[视觉模拟评分法（VAS）、Oswestry功能障碍指数（ODI）、日本骨科学会（JOA）下腰痛评分]，以评估术后1周、3个月、6个月及末次随访时不同椎间融合材料的临床疗效。
共纳入118例患者，其中自体骨组68例，PEEK组50例。两组患者在年龄、性别、BMI、初步诊断、融合节段分布、BMD、术前并发症发生率、手术时间、术中出血量、术后引流量、围手术期异体输血率、术后并发症发生率、所有术前影像学参数及所有腰椎功能评分方面比较，差异均无统计学意义（>0.05）。自体骨组有3例患者发生术后手术切口浅表感染，PEEK组有2例。末次随访时，自体骨组发生3例椎间植骨塌陷，PEEK组发生5例；自体骨组发生1例植骨下沉，PEEK组发生1例。所有影像学参数术后与术前比较差异均有统计学意义（<0.05）；两组术后第1周与第3个月比较，所有影像学参数差异均有统计学意义（<0.05）。术后第1周，自体骨组的融合间隙高度、角度低于PEEK组（<0.05），自体骨组的融合间隙高度改善率低于PEEK组（<0.05）。两组患者术后3个月开始出现最终融合，自体骨组术后6个月融合率为75%，显著高于PEEK组的56%（<0.05），两组最终融合率比较差异无统计学意义（>0.05）。ODI、术后VAS评分均显著低于术前，而术后JOA评分显著高于术前（<0.05）。术后6个月，自体骨组的ODI低于PEEK组，JOA评分高于PEEK组（<0.05）。
骨质疏松患者使用自体小关节骨块或PEEK椎间融合器均可获得良好的椎间融合率和腰椎功能改善，术后6个月时自体小关节骨块的融合率及腰椎功能改善情况优于PEEK椎间融合器。PEEK椎间融合器在椎间撑开及改善腰椎前凸方面优于自体小关节骨块。骨质疏松患者腰椎椎间融合术后3个月内发生明显的椎间隙下沉，PEEK椎间融合器的下沉比自体小关节骨块更明显。
