Department of Orthopedic Surgery, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA.
Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.
Eur Spine J. 2024 Sep;33(9):3476-3483. doi: 10.1007/s00586-024-08412-5. Epub 2024 Jul 17.
To determine of the impact of ALIF with minimally invasive unilateral pedicle screw fixation (UPSF) versus bilateral pedicle screw fixation (BPSF) on perioperative outcomes, radiographic outcomes, and the rates of fusion, subsidence, and adjacent segment stenosis.
All adult patients who underwent one-level ALIF with UPSF or BPSF at an academic institution between 2015 and 2022 were retrospectively identified. Postoperative outcomes including length of hospital stay (LOS), wound complications, readmissions, and revisions were determined. The rates of fusion, screw loosening, adjacent segment stenosis, and subsidence were assessed on one-year postoperative CT. Lumbar alignment including lumbar lordosis, L4-S1 lordosis, regional lordosis, pelvic tilt, pelvic incidence, and sacral slope were assessed on standing x-rays at preoperative, immediate postoperative, and final postoperative follow-up. Univariate and multivariate analysis compared outcomes across posterior fixation groups.
A total of 60 patients were included (27 UPSF, 33 BPSF). Patients with UPSF were significantly younger (p = 0.011). Operative time was significantly greater in the BPSF group in univariate (p < 0.001) and multivariate analysis (ß=104.1, p < 0.001). Intraoperative blood loss, LOS, lordosis, pelvic parameters, fusion rate, subsidence, screw loosening, adjacent segment stenosis, and revision rate did not differ significantly between fixation groups. Though sacral slope (p = 0.037) was significantly greater in the BPSF group, fixation type was not a significant predictor on regression.
ALIF with UPSF relative to BPSF predicted decreased operative time but was not a significant predictor of postoperative outcomes. ALIF with UPSF can be considered to increase operative efficiency without compromising construct stability.
确定前路椎间融合术（ALIF）联合微创单侧椎弓根螺钉固定（UPSF）与双侧椎弓根螺钉固定（BPSF）对围手术期结果、影像学结果以及融合率、下沉率和相邻节段狭窄率的影响。
回顾性分析了 2015 年至 2022 年期间在一家学术机构接受单节段 ALIF 联合 UPSF 或 BPSF 治疗的所有成年患者。确定了术后结果，包括住院时间（LOS）、伤口并发症、再入院和翻修。在术后 1 年的 CT 上评估了融合率、螺钉松动、相邻节段狭窄和下沉率。在术前、术后即刻和最终随访的站立 X 线上评估了腰椎排列，包括腰椎前凸角、L4-S1 前凸角、区域前凸角、骨盆倾斜度、骨盆入射角和骶骨倾斜度。在单变量和多变量分析中比较了后路固定组之间的结果。
共纳入 60 例患者（UPSF 组 27 例，BPSF 组 33 例）。UPSF 组患者明显更年轻（p=0.011）。BPSF 组手术时间在单变量（p<0.001）和多变量分析（β=104.1，p<0.001）中均显著较长。术中出血量、LOS、前凸角、骨盆参数、融合率、下沉率、螺钉松动、相邻节段狭窄率和翻修率在两组之间无显著差异。尽管 BPSF 组的骶骨倾斜角（p=0.037）显著更大，但固定类型并不是回归的显著预测因素。
与 BPSF 相比，ALIF 联合 UPSF 可预测手术时间缩短，但不是术后结果的显著预测因素。ALIF 联合 UPSF 可提高手术效率，而不会影响结构稳定性。
