Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
World Neurosurg. 2024 Mar;183:e51-e58. doi: 10.1016/j.wneu.2023.10.134. Epub 2023 Nov 2.
Ehlers-Danlos syndrome (EDS) is a collection of connective tissue disorders which are often associated with tissue laxity and disc degeneration. However, the implications of EDS on the risk of adjacent segment disease (ASD) after transforaminal lumbar interbody fusion (TLIF) are not well described. The objective of this study is to compare the rates of ASD among patients with EDS and those without EDS.
Patients who underwent 1-3 level TLIF for degenerative disc disease between 2010-2022 were identified using the PearlDiver Mariner all-claims insurance database. Patients with all types of EDS were included. Patients undergoing surgery for tumors, trauma, or infection were excluded. 1:1 propensity matching was performed using demographic factors, medical comorbidities, and surgical factors which were significantly associated with ASD in a linear regression model. The primary outcome measure was the development of ASD. The secondary outcomes were the development of pseudoarthrosis, medical complications, and surgical complications.
Propensity matching resulted in 2 equal groups of 85 patients who did or did not have EDS and underwent 1-3 level TLIF. Patients without EDS were less likely to experience ASD (RR 0.18, 95% CI 0.09-0.35, P < 0.001). There was no significant difference between the 2 patient groups with regards to a diagnosis of pseudoarthrosis, and there was no significant difference for all-cause medical and surgical complications between the 2 patient groups.
After propensity matching to control for confounding variables, the findings of this study suggest that EDS may be associated with an increased risk of ASD following TLIF. Future studies are needed to corroborate these findings.
埃勒斯-当洛斯综合征（EDS）是一组结缔组织疾病，常伴有组织松弛和椎间盘退变。然而，EDS 对经椎间孔腰椎体间融合术（TLIF）后邻近节段疾病（ASD）风险的影响尚未得到很好的描述。本研究的目的是比较 EDS 患者与无 EDS 患者 ASD 的发生率。
使用 PearlDiver Mariner 全部索赔保险数据库，确定了 2010 年至 2022 年间因退行性椎间盘疾病行 1-3 级 TLIF 的患者。纳入所有类型的 EDS 患者。排除因肿瘤、创伤或感染行手术的患者。使用线性回归模型中与 ASD 显著相关的人口统计学因素、合并症和手术因素进行 1:1 倾向匹配。主要结局指标为 ASD 的发生。次要结局指标为假关节形成、医疗并发症和手术并发症的发生。
倾向匹配后，有 EDS 并接受 1-3 级 TLIF 的 85 例患者和无 EDS 并接受 1-3 级 TLIF 的 85 例患者分为两组，每组各有 85 例。无 EDS 患者发生 ASD 的风险较低（RR 0.18，95%CI 0.09-0.35，P < 0.001）。两组患者的假关节诊断无显著差异，两组患者的所有原因医疗和手术并发症无显著差异。
在进行倾向匹配以控制混杂变量后，本研究的结果表明，EDS 可能与 TLIF 后 ASD 的风险增加有关。需要进一步的研究来证实这些发现。
