San Diego Spine Foundation, 6190 Cornerstone CT #212, San Diego, CA, 92121, USA.
University of California, San Diego, CA, USA.
Spine Deform. 2024 Nov;12(6):1831-1839. doi: 10.1007/s43390-024-00921-z. Epub 2024 Jul 13.
The evolution of MCGR technique has led to modifications in the configuration of the proximal construct to decrease the incidence of implant-related complications (IRC) and revision surgeries. However, there is no data characterizing the performance of the most used configurations reducing the risk of complications.
487 patients were identified from an international multicenter EOS database.
EOS patients, primary dual MCGR, complete radiographs, and minimum of 2-year follow-up. 76 patients had incomplete X-rays, 5 had apical fusions, and 18 had inconclusive complications, leaving 388 patients for review. A digital spine template was created to document UIV; number of levels; number, type, and location of anchors; as well as implant configuration. First available postoperative and latest follow-up radiographs were reviewed by two senior surgeons and two spine fellows. UPROR due to IRC was defined as any change in proximal anchors between the postoperative and final follow-up radiographs.
The most common proximal construct configuration: UIV at T2 (50.0%) with 17.5% UPROR, followed by T3 (34.0%) with 12.1% UPROR; number of levels was three (57.1%) with 16.8% UPROR and two (26.0%) with 17.0% UPROR; number of proximal anchors was six (49.9%) with 14.1% UPROR and four (27.0%) with 18.3% UPROR. The most common anchors were all screws (42.0%) with 9.9% UPROR, and all hooks (26.4%) with 31.4% UPROR (P < 0.001). The construct with the lowest rate of UPROR was a UIV at T2, with six anchors (all screws) across three levels (42 cases), with 0% UPROR. Other construct combinations that yielded 0% UPROR rates were UIV of T3, six anchors (all screws) across three levels (25 cases), and a UIV of T3 with six anchors (screws and hooks) across three3 levels (9 cases).
Proximal anchor configuration impacts the incidence of UPROR due to IRC in MCGR. UIV at T2 and T3 compared to T4, and the use of all screws or combination of screws and hooks compared to all hooks were associated with a lower UPROR rate. The most common construct configuration was T2 UIV, three levels, six anchors, and all screws. The use of a combination of six anchors (screws or screws and hooks) across three levels with a UIV at T2 or T3 was associated with a lower UPROR rate. Additional research is needed to further evaluate the variables contributing to configuration selection and their association with IRC.
MCGR 技术的发展导致了近端结构配置的修改，以降低与植入物相关的并发症（IRC）和翻修手术的发生率。然而，目前尚无数据描述降低并发症风险的最常用配置的性能。
从国际多中心 EOS 数据库中确定了 487 名患者。
EOS 患者，初次双 MCGR，完整的 X 光片，至少 2 年的随访。76 名患者的 X 光片不完整，5 名患者存在根尖融合，18 名患者的并发症不确定，留下 388 名患者进行回顾。创建了一个数字脊柱模板来记录 UIV；水平数量；数量、类型和位置的锚；以及植入物配置。由两位资深外科医生和两位脊柱研究员审查首次获得的术后和最新的随访 X 光片。由于 IRC 导致的 UPROR 被定义为术后和最终随访 X 光片之间近端锚的任何变化。
最常见的近端结构配置：T2 处的 UIV（50.0%），UPROR 为 17.5%，其次是 T3（34.0%），UPROR 为 12.1%；水平数量为三个（57.1%），UPROR 为 16.8%，两个（26.0%），UPROR 为 17.0%；近端锚数量为六个（49.9%），UPROR 为 14.1%，四个（27.0%），UPROR 为 18.3%。最常见的锚是所有螺钉（42.0%），UPROR 为 9.9%，所有钩（26.4%），UPROR 为 31.4%（P<0.001）。UPROR 发生率最低的结构组合是 T2 处的 UIV，有六个锚（均为螺钉）横跨三个水平（42 例），无 UPROR。其他 UPROR 发生率为 0%的结构组合是 T3 处的 UIV、横跨三个水平的六个锚（均为螺钉）（25 例）和 T3 处的 UIV、横跨三个水平的六个锚（螺钉和钩）（9 例）。
MCGR 中，近端锚结构配置会影响 IRC 导致的 UPROR 发生率。与 T4 相比，T2 和 T3 的 UIV 以及全部使用螺钉或螺钉和钩的组合与较低的 UPROR 率相关。最常见的结构配置是 T2 UIV、三个水平、六个锚和所有螺钉。在 T2 或 T3 处使用横跨三个水平的六个锚（螺钉或螺钉和钩）与较低的 UPROR 率相关。需要进一步的研究来进一步评估导致配置选择的变量及其与 IRC 的关系。
