Matsumoto Tomiya, Okuda Shinya, Nagamoto Yukitaka, Takahashi Yoshifumi, Furuya Masayuki, Iwasaki Motoki
Department of Orthopaedic Surgery, Osaka Rosai Hospital, Sakai, Japan.
J Spine Surg. 2023 Sep 22;9(3):269-277. doi: 10.21037/jss-23-78. Epub 2023 Sep 18.
The importance of spinopelvic sagittal alignment for adjacent segment disease (ASD) after lumbar fusion surgery has been reported. However, no longitudinal cohort studies have determined the extent to which segmental alignment and spinopelvic global alignment can be achieved using 12° lordotic cages in posterior lumbar inter-body fusion (PLIF) and the extent to which the development of ASD can be prevented. The purpose of this study was to analyze changes in segmental and spinopelvic sagittal alignment after single-segment PLIF with 12° lordotic cages, to clarify the relationship between changes in segmental and spinopelvic sagittal alignment, and to report the incidence of ASD at 2 years postoperatively.
Subjects in this 2-year prospective longitudinal cohort study were 28 patients who had undergone L4/5 PLIF using 12° lordotic cages. Incidence of operative ASD (O-ASD) was evaluated as clinical outcomes. Radiological measurements were examined preoperatively and at 3 months, 1 year and 2 years postoperatively. The following radiographic spinopelvic parameters were measured: segmental lordosis (SL) at L4/5; sagittal vertical axis (SVA); T1 pelvic angle (TPA); thoracic kyphosis (TK); lumbar lordosis (LL); sacral slope (SS); pelvic tilt (PT); and pelvic incidence (PI). With respect to radiological outcomes, changes in SL (ΔSL) and spinopelvic parameters and the incidence of radiological ASD (R-ASD) were evaluated. Correlations of ΔSL and changes in other spinopelvic parameters (ΔSVA, ΔTPA, ΔTK, ΔLL, ΔSS, ΔPT, and ΔPI-LL) between preoperatively and 3 months postoperatively were examined.
The follow-up rate was 100% (n=28) at 1 year postoperatively and 96.4% (n=27) at 2 years postoperatively. No cases of O-ASD were seen during 2 years of follow-up. Significant realignment was observed and maintained at 2 years postoperatively in almost all spinopelvic sagittal parameters (SL, SVA, TPA, LL, PT, PI-LL). Regarding the correlation between ΔSL and other parameters, significant correlations were detected with ΔSVA (r=-0.37, P<0.05) and ΔLL (r=0.538, P<0.01). Three cases (11.1%) showed R-ASD at 2 years postoperatively.
PLIF with 12° lordotic cages for L4 degenerative spondylolisthesis improved SL and global sagittal realignment, and achieved satisfactory clinical outcomes with a low incidence of ASD during 2 years of follow-up.
已有报道指出腰椎融合术后脊柱骨盆矢状面排列对于相邻节段疾病（ASD）的重要性。然而，尚无纵向队列研究确定在腰椎后路椎间融合术（PLIF）中使用12°前凸椎间融合器可实现节段排列和脊柱骨盆整体排列的程度，以及可预防ASD发生的程度。本研究的目的是分析采用12°前凸椎间融合器进行单节段PLIF术后节段和脊柱骨盆矢状面排列的变化，阐明节段和脊柱骨盆矢状面排列变化之间的关系，并报告术后2年ASD的发生率。
本为期2年的前瞻性纵向队列研究的受试者为28例行L4/5 PLIF并使用12°前凸椎间融合器的患者。将手术性ASD（O-ASD）的发生率评估为临床结局。在术前以及术后3个月、1年和2年进行影像学测量。测量以下影像学脊柱骨盆参数：L4/5节段前凸（SL）；矢状垂直轴（SVA）；T1骨盆角（TPA）；胸椎后凸（TK）；腰椎前凸（LL）；骶骨倾斜度（SS）；骨盆倾斜度（PT）；以及骨盆入射角（PI）。关于影像学结局，评估SL的变化（ΔSL）、脊柱骨盆参数以及影像学ASD（R-ASD）的发生率。检查术前与术后3个月之间ΔSL与其他脊柱骨盆参数变化（ΔSVA、ΔTPA、ΔTK、ΔLL、ΔSS、ΔPT和ΔPI-LL）之间的相关性。
术后1年随访率为100%（n = 28），术后2年随访率为96.4%（n = 27）。在2年随访期间未观察到O-ASD病例。几乎所有脊柱骨盆矢状面参数（SL、SVA、TPA、LL、PT、PI-LL）在术后2年均观察到并维持了显著的重新排列。关于ΔSL与其他参数之间的相关性，检测到与ΔSVA（r = -0.37，P < 0.05）和ΔLL（r = 0.538，P < 0.01）存在显著相关性。3例（11.1%）在术后2年出现R-ASD。
采用12°前凸椎间融合器治疗L4退行性椎体滑脱的PLIF改善了SL和整体矢状面重新排列，并在2年随访期间获得了满意的临床结局，ASD发生率较低。
