Narendran Nakul, Mikhail Christopher M, Nilssen Paal K, Tuchman Alexander, Skaggs David L
Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Global Spine J. 2025 Apr;15(3):1733-1742. doi: 10.1177/21925682241260733. Epub 2024 Jun 11.
Study DesignRetrospective Matched Cohort.ObjectiveDespite known consequences to the facet joints following lumbar total disc replacement (TDR), there is limited data on facet injection usage for persistent postoperative pain. This study uses real-world data to compare the usage of therapeutic lumbar facet injections as a measure of symptomatic facet arthrosis following single-level, stand-alone TDR vs anterolateral lumbar interbody fusion (ALIF/LLIF).MethodsThe PearlDiver database was queried for patients (2010-2021) with lumbar degenerative disc disease who received either a single-level, stand-alone TDR or ALIF/LLIF. All patients were followed for ≥2 years and excluded if they had a history of facet injections or spinal trauma, fracture, infection, or neoplasm. The two cohorts were matched 1:1 based on age, sex, insurance, year of operation, and medical comorbidities. The primary outcome was the use of therapeutic lumbar facet injections at 1-, 2-, and 5-year follow-up. Secondary outcomes included subsequent lumbar surgeries and surgical complications.ResultsAfter 1:1 matching, each cohort had 1203 patients. Lumbar facet injections occurred significantly more frequently in the TDR group at 1-year (6.07% vs 1.66%, < .0001), 2-year (8.40% vs 3.74%%, < .0001), and 5-year (11.47% vs 6.40%, < .0001) follow-up. 5-year injection-free probability curves demonstrated an 87.1% injection-free rate for TDR vs 92.9% for ALIF/LLIF. There was no clinical difference in the incidence of subsequent lumbar surgeries or complications.ConclusionCompared with ALIF/LLIF, patients who underwent TDR received significantly more facet injections, suggesting a greater progression of symptomatic facet arthrosis. TDR was not protective against reoperations compared to ALIF/LLIF.
研究设计
回顾性匹配队列研究。
目的
尽管已知腰椎全椎间盘置换术（TDR）后小关节会产生一些后果，但关于术后持续性疼痛使用小关节注射的数据有限。本研究使用真实世界数据比较单节段、独立TDR与腰椎前外侧椎间融合术（ALIF/LLIF）后，治疗性腰椎小关节注射作为症状性小关节骨关节炎指标的使用情况。
方法
在PearlDiver数据库中查询2010年至2021年患有腰椎退行性椎间盘疾病且接受单节段、独立TDR或ALIF/LLIF的患者。所有患者随访≥2年，若有小关节注射史或脊柱创伤、骨折、感染或肿瘤病史则排除。根据年龄、性别、保险、手术年份和医疗合并症将两个队列进行1:1匹配。主要结局是在1年、2年和5年随访时使用治疗性腰椎小关节注射的情况。次要结局包括随后的腰椎手术和手术并发症。
结果
1:1匹配后，每个队列有1203例患者。在1年（6.07%对1.66%，P<0.0001）、2年（8.40%对3.74%，P<0.0001）和5年（11.47%对6.40%，P<0.0001）随访时，TDR组腰椎小关节注射的发生率显著更高。5年无注射概率曲线显示，TDR组无注射率为87.1%，而ALIF/LLIF组为92.9%。随后腰椎手术或并发症的发生率无临床差异。
结论
与ALIF/LLIF相比，接受TDR的患者接受小关节注射的次数显著更多，提示症状性小关节骨关节炎进展更大。与ALIF/LLIF相比，TDR对再次手术没有保护作用。
