Mullin Jeffrey P, Asghar Jahangir, Patel Ashvin I, Osorio Joseph A, Smith Justin S, Ames Christopher P, Small John, Desai Atman, Ponticorvo Adrien, Nicolau Rodrigo J
Department of Neurosurgery, University at Buffalo, Buffalo, NY, USA
Department of Spine Surgery, Elite Spine Health and Wellness, Plantation, FL, USA.
Int J Spine Surg. 2024 Aug 30;18(S1):S32-S40. doi: 10.14444/8639.
An abnormal postoperative lordosis distribution index (LDI), which quantifies the ratio between the lordosis at L4 to S1 and the lordosis at L1 to S1, contributes to the development of adjacent segment disease and increased revision rates in patients undergoing short-segment lumbar intervertebral fusions. Incorporating preoperative spinopelvic parameters and LDI into the surgical plan for short-segment fusion is important for guiding alignment restoration and preserving normal preoperative alignment in unfused segments. This study examined changes in LDI, segmental lordosis, and lordosis of the unfused levels in patients treated with personalized interbody cage (PIC) implants.
This retrospective study evaluated radiographic measurements from 111 consecutively treated patients diagnosed with degenerative spinal conditions and treated with a short-segment fusion of L4 to L5, L5 to S1, or L4 to S1 using PIC implant(s) within 6 months of the fusion procedure. Comparisons of intervertebral lordosis for treated and untreated levels as well as LDI pre- and postoperatively were performed.
In patients with a preoperative hypolordotic distribution (LDI < 50%), statistically significant increases were found in LDI postoperatively, approaching the normal LDI range (LDI 50%-80%). Likewise, patients with hyperlordotic distribution preoperatively (LDI > 80%) experienced a decrease in LDI postoperatively, trending toward the normal range, although the changes were not statistically significant. Intervertebral lordosis for the L5 to S1 level increased significantly following the placement of a PIC in the normal and hypolordotic LDI groups. Changes in intervertebral lordosis for L5 to S1 were not significant for patients with preoperative hyperlordotic LDI. Reciprocal changes in intervertebral lordosis at L1 to L4 were not observed in any groups.
PIC implants may provide a benefit for patients, particularly those with hypolordotic distributions preoperatively. They have the potential to further improve patient outcomes by helping surgeons to achieve patient-specific lordosis goals, which may help to reduce the risk of adjacent segment disease and revisions in patients undergoing short-segment lumbar intervertebral fusions.
Personalized implants can help surgeons achieve patient-specific alignment goals, potentially prevent adjacent segment disease, and reduce long-term reinterventions.
术后腰椎前凸分布指数（LDI）异常，即L4至S1节段的前凸与L1至S1节段的前凸之比，会导致相邻节段疾病的发生，并增加接受短节段腰椎融合术患者的翻修率。将术前脊柱骨盆参数和LDI纳入短节段融合手术计划对于指导恢复对线以及维持未融合节段术前的正常对线非常重要。本研究探讨了使用个性化椎间融合器（PIC）植入物治疗的患者LDI、节段性前凸以及未融合节段前凸的变化。
这项回顾性研究评估了111例连续接受治疗的患者的影像学测量结果，这些患者被诊断为退行性脊柱疾病，并在融合手术6个月内接受了L4至L5、L5至S1或L4至S1的短节段融合术，使用了PIC植入物。对治疗节段和未治疗节段的椎间前凸以及术前和术后的LDI进行了比较。
术前前凸分布减低（LDI<50%）的患者，术后LDI有统计学意义的增加，接近正常LDI范围（LDI 50%-80%）。同样，术前前凸分布增加（LDI>80%）的患者术后LDI降低，虽变化无统计学意义，但有趋向正常范围的趋势。在正常和前凸分布减低的LDI组中，植入PIC后L5至S1节段的椎间前凸显著增加。术前前凸分布增加的LDI患者，L5至S1节段的椎间前凸变化不显著。任何组均未观察到L1至L4节段椎间前凸的相反变化。
PIC植入物可能对患者有益，尤其是术前前凸分布减低的患者。它们有可能通过帮助外科医生实现患者特定的前凸目标来进一步改善患者预后，这可能有助于降低接受短节段腰椎融合术患者发生相邻节段疾病和翻修的风险。
个性化植入物可帮助外科医生实现患者特定的对线目标，有可能预防相邻节段疾病，并减少长期再次干预。
