Kwon Ji-Won, Park Yung, Suk Kyung-Soo, Lee Byung Ho, Park Si Young, Park Sub-Ri, Kim Namhoo, Lee Hyunjun, Jung Wooseok, Ha Joong-Won, Moon Seong-Hwan, Kim Hak-Sun
Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea.
Spine (Phila Pa 1976). 2024 Dec 15;49(24):1729-1736. doi: 10.1097/BRS.0000000000005003. Epub 2024 Apr 5.
Retrospective observational study.
To determine the proximity between the screw and endplate of the upper instrumented vertebra (UIV) using a cortical bone trajectory (CBT) screw as a predictive factor for radiographic adjacent segment degeneration (ASD) in patients surgically treated with transforaminal lumbar interbody fusion (TLIF) with CBT screws (CBT-TLIF) with lumbar spinal stenosis.
The risk factors for radiographic ASD after CBT-TLIF remain unknown.
Among patients surgically treated with CBT-TLIF at a single institute, 239 consecutive patients (80 males and 159 females) were enrolled. ASD was defined by the presence of one or more of the following three radiologic criteria on the adjacent segment: >3 mm anteroposterior translation, >10° segmental kyphosis, or >50% loss of disc height comparing immediate postoperative and one-year follow-up radiographs. Clinical and radiological features associated with the development of ASD were retrospectively measured. Univariate and multivariate analyses were performed to identify risk factors associated with radiographic ASD.
Radiographic ASD was observed in 71 (29.7%) cases at one-year postoperative follow-up. The preoperative Pfirrmann grade of the adjacent segment (>grade 2), multi-level fusion (>2 levels), and proximity between the tip of CBT screws and endplate on the UIV were significantly associated with radiographic ASD (OR = 3.98, 95% CI [1.06-15.05], P =0.042 versus OR = 3.03, 95% CI [1.00-9.14], P =0.049 versus OR = 0.53, 95% CI [0.40-0.72], P <0.001). The cut-off value of the distance between the tip of the screw and endplate on UIV for radiographic ASD was ~2.5 mm (right-sided CBT screw; cut-off value 2.48 mm/ left-sided CBT screw; cut-off value 2.465 mm).
Radiographic adjacent segment degeneration progression can occur when the cortical trajectory bone screw is close to the endplate of the upper instrumented vertebrae in patients with lumbar spinal stenosis undergoing fusion surgery.
回顾性观察研究。
使用皮质骨轨迹（CBT）螺钉确定上位固定椎体（UIV）螺钉与终板之间的距离，作为腰椎管狭窄症患者接受经椎间孔腰椎椎间融合术（TLIF）联合CBT螺钉（CBT-TLIF）手术治疗后影像学相邻节段退变（ASD）的预测因素。
CBT-TLIF术后影像学ASD的危险因素尚不清楚。
在一家机构接受CBT-TLIF手术治疗的患者中，连续纳入239例患者（80例男性和159例女性）。ASD定义为相邻节段出现以下三项放射学标准中的一项或多项：前后移位>3mm、节段性后凸>10°或与术后即刻及一年随访X线片相比椎间盘高度丢失>50%。回顾性测量与ASD发生相关的临床和放射学特征。进行单因素和多因素分析以确定与影像学ASD相关的危险因素。
术后一年随访时，71例（29.7%）患者出现影像学ASD。相邻节段术前Pfirrmann分级（>2级）、多节段融合（>2个节段）以及UIV上CBT螺钉尖端与终板之间的距离与影像学ASD显著相关（比值比=3.98，95%置信区间[1.06-15.05]，P=0.042；比值比=3.03，95%置信区间[1.00-9.14]，P=0.049；比值比=0.53，95%置信区间[0.40-0.72]，P<0.001）。UIV上螺钉尖端与终板之间的距离对于影像学ASD的截断值约为2.5mm（右侧CBT螺钉；截断值2.48mm/左侧CBT螺钉；截断值2.465mm）。
在接受融合手术的腰椎管狭窄症患者中，当皮质轨迹骨螺钉靠近上位固定椎体的终板时，可能会发生影像学相邻节段退变进展。
