前路腰椎间融合术（ALIF）+经皮内固定术（PS）、经后路腰椎间融合术（PLIF）+PS、经椎间孔腰椎间融合术（TLIF）+PS 和经椎间孔腰椎体间融合术（LLIF）+PS 治疗相邻节段病变的再次手术率是否存在差异？对 5291 例患者队列的分析。

Are there differences in the reoperation rates for operative adjacent-segment disease between ALIF+PS, PLIF+PS, TLIF+PS, and LLIF+PS? An analysis of a cohort of 5291 patients.

机构信息

1The Permanente Medical Group, Oakland, California.

2Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, California; and.

出版信息

J Neurosurg Spine. 2024 Mar 8;40(6):733-740. doi: 10.3171/2023.12.SPINE231251. Print 2024 Jun 1.

DOI:10.3171/2023.12.SPINE231251

PMID:38457789

Abstract

OBJECTIVE

Biomechanical factors in lumbar fusions accelerate the development of adjacent-segment disease (ASD). Stiffness in the fused segment increases motion in the adjacent levels, resulting in ASD. The objective of this study was to determine if there are differences in the reoperation rates for symptomatic ASD (operative ASD) between anterior lumbar interbody fusion plus pedicle screws (ALIF+PS), posterior lumbar interbody fusion plus pedicle screws (PLIF+PS), transforaminal lumbar interbody fusion plus pedicle screws (TLIF+PS), and lateral lumbar interbody fusion plus pedicle screws (LLIF+PS).

METHODS

A retrospective study using data from the Kaiser Permanente Spine Registry identified an adult cohort (≥ 18 years old) with degenerative disc disease who underwent primary lumbar interbody fusions with pedicle screws between L3 to S1. Demographic and operative data were obtained from the registry, and chart review was used to document operative ASD. Patients were followed until operative ASD, membership termination, the end of study (March 31, 2022), or death. Operative ASD was analyzed using Cox proportional hazards models.

RESULTS

The final study population included 5291 patients with a mean ± SD age of 60.1 ± 12.1 years and a follow-up of 6.3 ± 3.8 years. There was a total of 443 operative ASD cases, with an overall incidence rate of reoperation for ASD of 8.37% (95% CI 7.6-9.2). The crude incidence of operative ASD at 5 years was the lowest in the ALIF+PS cohort (7.7%, 95% CI 6.3-9.4). In the adjusted models, the authors failed to detect a statistical difference in operative ASD between ALIF+PS (reference) versus PLIF+PS (HR 1.06 [0.79-1.44], p = 0.69) versus TLIF+PS (HR 1.03 [0.81-1.31], p = 0.83) versus LLIF+PS (HR 1.38 [0.77-2.46], p = 0.28).

CONCLUSIONS

In a large cohort of over 5000 patients with an average follow-up of > 6 years, the authors found no differences in the reoperation rates for symptomatic ASD (operative ASD) between ALIF+PS and PLIF+PS, TLIF+PS, or LLIF+PS.

摘要

目的

腰椎融合术的生物力学因素加速了邻近节段疾病（ASD）的发展。融合节段的僵硬增加了相邻节段的运动，导致 ASD。本研究的目的是确定前路腰椎体间融合加椎弓根螺钉（ALIF+PS）、后路腰椎体间融合加椎弓根螺钉（PLIF+PS）、经椎间孔腰椎体间融合加椎弓根螺钉（TLIF+PS）和侧路腰椎体间融合加椎弓根螺钉（LLIF+PS）治疗有症状的 ASD（手术 ASD）的再手术率是否存在差异。

方法

回顾性研究使用 Kaiser Permanente 脊柱登记处的数据，确定了一个接受 L3 至 S1 后路腰椎体间融合加椎弓根螺钉的退行性椎间盘疾病成年队列（≥ 18 岁）。从登记处获得人口统计学和手术数据，并进行病历回顾以记录手术 ASD。患者随访至手术 ASD、会员资格终止、研究结束（2022 年 3 月 31 日）或死亡。使用 Cox 比例风险模型分析手术 ASD。

结果

最终的研究人群包括 5291 名患者，平均年龄 60.1 ± 12.1 岁，随访 6.3 ± 3.8 年。共有 443 例手术 ASD 病例，手术 ASD 的总再手术率为 8.37%（95%CI 7.6-9.2）。ALIF+PS 队列的 5 年手术 ASD 发生率最低（7.7%，95%CI 6.3-9.4）。在调整后的模型中，作者未能检测到 ALIF+PS（参考）与 PLIF+PS（HR 1.06[0.79-1.44]，p=0.69）、TLIF+PS（HR 1.03[0.81-1.31]，p=0.83）和 LLIF+PS（HR 1.38[0.77-2.46]，p=0.28）之间手术 ASD 存在统计学差异。