Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, PA.
Department of Orthopaedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO.
Spine (Phila Pa 1976). 2024 Nov 15;49(22):1598-1606. doi: 10.1097/BRS.0000000000005109. Epub 2024 Jul 26.
Retrospective cohort study.
The purpose of this study is to determine which demographic, surgical, and radiographic preoperative characteristics are most associated with the need for subsequent fusion after decompression lumbar spinal surgery.
There is a relatively high rate of the need for repeat decompression or fusion after an index decompression procedure for degenerative spine disease. Nevertheless, there is a dearth of literature identifying risk factors for lumbar fusion following decompression surgery.
Patients 18 years or older receiving a primary lumbar decompression surgery within the levels of L3-S1 between 2011 and 2020 were identified. All patients had preoperative radiographs and 2 years of follow-up data. Chart review was performed for surgical characteristics and demographics. The sagittal parameters included lumbar lordosis (LL), segmental lordosis (SL), anterior disk height (aDH), posterior disk height (pDH), sacral slope (SS), and pelvic tilt (PT). Pelvic incidence (PI=PT+SS) and pelvic incidence minus lumbar lordosis (PI-LL) were calculated. In addition, the Roussouly classification was determined for each patient. Bivariant and multivariant analyses were performed.
Of the 363 patients identified in this study, 96 patients had a fusion after their index decompression surgery. Multivariable analysis identified involvement of L4-L5 level in the decompression [odds ratio (OR)=1.83 (1.09-3.14), P =0.026], increased L5-S1 segmental lordosis [OR=1.08 (1.03-1.13), P =0.001], decreased SS [OR=0.96 (0.93-0.99), P =0.023], and decreased endplate obliquity [OR=0.88 (0.77-0.99), P =0.040] as significant independent predictors of fusion after decompression surgery.
This is one of the first studies to assess preoperative sagittal parameters in conjunction with demographic variables to determine predictors of the need for fusion after index decompression. We demonstrated that decompression at L4-L5, greater L5-S1 segmental lordosis, decreased sacral slope, and decreased endplate obliquity were associated with higher rates of fusion after decompression surgery.
回顾性队列研究。
本研究旨在确定哪些人口统计学、手术和影像学术前特征与减压腰椎手术后需要后续融合的关系最密切。
退行性脊柱疾病的减压指数程序后，需要重复减压或融合的比率相对较高。然而，目前缺乏识别减压手术后腰椎融合危险因素的文献。
在 2011 年至 2020 年期间，确定在 L3-S1 水平接受初次腰椎减压手术的 18 岁或以上患者。所有患者均有术前影像学资料和 2 年随访数据。对手术特征和人口统计学数据进行图表审查。矢状参数包括腰椎前凸（LL）、节段前凸（SL）、前椎间盘高度（aDH）、后椎间盘高度（pDH）、骶骨倾斜（SS）和骨盆倾斜（PT）。骨盆入射角（PI=PT+SS）和骨盆入射角减去腰椎前凸（PI-LL）被计算出来。此外，为每位患者确定了 Roussouly 分类。进行了双变量和多变量分析。
在这项研究中，确定了 363 名患者，其中 96 名患者在指数减压手术后进行了融合。多变量分析确定了减压手术涉及 L4-L5 水平[比值比（OR）=1.83（1.09-3.14），P=0.026]、增加的 L5-S1 节段前凸[OR=1.08（1.03-1.13），P=0.001]、减少的 SS[OR=0.96（0.93-0.99），P=0.023]和减少的终板倾斜[OR=0.88（0.77-0.99），P=0.040]是减压手术后融合的显著独立预测因子。
这是评估术前矢状参数与人口统计学变量相结合以确定指数减压后融合需求预测因子的首批研究之一。我们表明，L4-L5 减压、更大的 L5-S1 节段前凸、减少的骶骨倾斜和减少的终板倾斜与减压手术后更高的融合率相关。
