Shellock Jessica L, Zigler Jack E, Blumenthal Scott L, Guyer Richard D, Ohnmeiss Donna D
Center for Disc Replacement at the Texas Back Institute, Plano, TX.
Texas Back Institute Research Foundation, Plano, TX.
Spine (Phila Pa 1976). 2025 Jan 15;50(2):110-114. doi: 10.1097/BRS.0000000000005052. Epub 2024 May 29.
This was a retrospective study combined with attempted prospective patient contact to collect current data.
The purpose of this study was to investigate the long-term clinical outcomes of patients undergoing lumbar hybrid surgery (total disk replacement (TDR) at one level and fusion at an adjacent level.
Many patients with symptomatic lumbar disk degeneration are affected at more than one level. Lumbar TDR was introduced as a fusion alternative; however, some disk levels are not amenable to TDR, and fusion is preferable at such levels. Hybrid surgery was introduced as an option to fusing multiple levels.
A consecutive series of 305 patients undergoing lumbar hybrid surgery was identified, beginning with the first case experience in 2005. Operative and clinical outcome data, including visual analog scales (VAS) assessing back and leg pain, Oswestry Disability Index (ODI), and reoperations, were collected. The mean follow-up duration was 67.1 months.
There were statistically significant improvements ( P <0.01) in the mean values of all three clinical outcome measures: VAS back pain scores improved from 6.7 to 3.3; leg pain improved from 4.3 to 2.0; and ODI scores improved from 45.5 to 24.6. There were no significant differences in pain and function scores for patients with a minimum 10-year follow-up versus those with a shorter follow-up duration. Re-operation occurred in 16.1% of patients, many of which involved removal of posterior instrumentation at the fusion level (6.2% of the study group, 38.8% of re-operations). Reoperation involving the TDR level occurred in 9 patients (2.9%), only 3 of which (1.0%) involved TDR removal/revision.
This study supports that for many patients with multilevel symptomatic disk degeneration, hybrid surgery is a viable surgical option. Significant improvements were demonstrated in pain and function scores, with no diminished improvement in scores among patients with more than 10-year follow-up.
Level IV.
这是一项回顾性研究，并尝试进行前瞻性患者联系以收集当前数据。
本研究的目的是调查接受腰椎混合手术（一个节段进行全椎间盘置换（TDR），相邻节段进行融合）患者的长期临床结局。
许多有症状的腰椎间盘退变患者不止一个节段受累。腰椎TDR作为一种融合替代方法被引入；然而，一些椎间盘节段不适合进行TDR，在这些节段融合更可取。混合手术作为融合多个节段的一种选择被引入。
从2005年的首例病例开始，确定了连续305例行腰椎混合手术的患者。收集手术和临床结局数据，包括评估腰腿痛的视觉模拟量表（VAS）、Oswestry功能障碍指数（ODI）和再次手术情况。平均随访时间为67.1个月。
所有三项临床结局指标的平均值均有统计学显著改善（P<0.01）：VAS腰背痛评分从6.7改善至3.3；腿痛从4.3改善至2.0；ODI评分从45.5改善至24.6。随访至少10年的患者与随访时间较短的患者在疼痛和功能评分上无显著差异。16.1%的患者进行了再次手术，其中许多涉及融合节段后路内固定物的取出（占研究组的6.2%，占再次手术的38.8%）。涉及TDR节段的再次手术有9例（2.9%），其中仅3例（1.0%）涉及TDR取出/翻修。
本研究支持对于许多多节段有症状椎间盘退变患者，混合手术是一种可行的手术选择。疼痛和功能评分有显著改善，随访超过10年的患者评分改善并未减弱。
四级。
