Durand Wesley M, Quan Theodore, Parekh Yesha, Yoon S Tim, Hsieh Patrick C, Le Hai, Louie Philip K, Corluka Stipe, Singh Hardeep, Cho Samuel K, Muthu Sathish, Buser Zori, Hamouda Waeel, Demetriades Andreas K, Vadalà Gianluca, Jain Amit
Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.
Department of Orthopaedic Surgery, George Washington University, Washington, DC, USA.
Global Spine J. 2025 Mar 12:21925682251326914. doi: 10.1177/21925682251326914.
Study DesignRetrospective Cohort Study.ObjectiveIsthmic spondylolisthesis is frequently encountered in spine surgical practice, though there is a significant variation in surgical management strategies. We sought to evaluate revision rates between patients who underwent anterior-approach lumbar interbody fusion (ALIF) alone, posterolateral fusion (PLF) alone, PLIF/TLIF, and ALIF+PSF.MethodsThis retrospective study utilized a large commercial insurance claims database of patients ≤65 years-old. Patients with isthmic spondylolisthesis who underwent single-level instrumented arthrodesis were included, and those who underwent revision surgery, surgery for deformity, multi-level surgery, or surgery for traumatic, infectious, or neoplastic etiologies were excluded, as determined by ICD-10-CM and CPT codes. Patients were assigned to surgical cohorts of ALIF alone, PLF alone, PLIF/TLIF, and ALIF+PSF based on CPT codes. Additional independent variables included age, sex, decompression at index surgery, and region. The primary outcome was revision arthrodesis or decompression, defined using CPT codes. Kaplan-Meier analysis and Cox Proportional Hazards regression were utilized to assess differences in revision occurrence between cohorts.Results1014 patients who underwent single-level arthrodesis for isthmic spondylolisthesis were included. The mean age was 48.6 years, with a mean follow-up of 637.6 days. The majority of patients underwent PLIF/TLIF (60.6%, n = 614), followed by ALIF+PSF (18.5%, n = 188), PLF alone (14.4%, n = 146), and ALIF alone (6.5%, n = 66). The 5-year revision-rate was 11.0% for all patients in the Kaplan-Meier analysis. In multivariable analysis adjusting for confounding factors, ALIF-alone demonstrated significantly higher occurrence of revision compared to both ALIF+PSF (HR 5.0, = 0.0026) and PLIF/TLIF (HR 5.8, < 0.0001) groups. Similarly, PLF alone demonstrated significantly higher occurrence of revision surgery compared to PLIF/TLIF (HR 2.4, = 0.0379) while other comparisons were not statistically significant.ConclusionsIn this analysis of single-level arthrodesis for isthmic spondylolisthesis, patients who underwent ALIF alone had higher revision rates than those who underwent PLIF/TLIF and ALIF+PSF surgery, and those who underwent PLF alone had higher revision rates than those who underwent PLIF/TLIF. Surgical strategies providing both anterior and posterior column support resulted in lower real-world revision rates.
研究设计
回顾性队列研究。
目的
峡部裂型腰椎滑脱在脊柱外科手术中较为常见，但其手术治疗策略存在显著差异。我们旨在评估单纯前路腰椎椎间融合术（ALIF）、单纯后外侧融合术（PLF）、经椎间孔腰椎椎体间融合术/经椎间孔腰椎椎体间融合术（PLIF/TLIF）以及ALIF + 后路脊柱固定融合术（PSF）患者的翻修率。
方法
这项回顾性研究利用了一个大型商业保险理赔数据库，纳入年龄≤65岁的患者。纳入接受单节段器械辅助脊柱融合术治疗峡部裂型腰椎滑脱的患者，根据ICD - 10 - CM和CPT编码排除接受翻修手术、畸形矫正手术、多节段手术或因创伤、感染或肿瘤病因进行手术的患者。根据CPT编码将患者分配到单纯ALIF、单纯PLF、PLIF/TLIF和ALIF + PSF手术队列。其他独立变量包括年龄、性别、初次手术时的减压情况以及手术部位。主要结局是使用CPT编码定义的翻修性脊柱融合术或减压术。采用Kaplan - Meier分析和Cox比例风险回归评估各队列之间翻修发生率的差异。
结果
纳入1014例接受单节段峡部裂型腰椎滑脱脊柱融合术的患者。平均年龄为48.6岁，平均随访637.6天。大多数患者接受PLIF/TLIF手术（60.6%，n = 614），其次是ALIF + PSF手术（18.5%，n = 188）、单纯PLF手术（14.4%，n = 146）和单纯ALIF手术（6.5%，n = 66）。在Kaplan - Meier分析中，所有患者的5年翻修率为11.0%。在调整混杂因素的多变量分析中，单纯ALIF组与ALIF + PSF组（风险比[HR] 5.0，P = 0.0026）和PLIF/TLIF组（HR 5.8，P < 0.0001）相比，翻修发生率显著更高。同样，单纯PLF组与PLIF/TLIF组相比，翻修手术发生率显著更高（HR 2.4，P = 0.0379），而其他比较无统计学意义。
结论
在这项对峡部裂型腰椎滑脱单节段脊柱融合术的分析中，单纯接受ALIF手术的患者比接受PLIF/TLIF和ALIF + PSF手术的患者翻修率更高，单纯接受PLF手术的患者比接受PLIF/TLIF手术的患者翻修率更高。提供前后柱支撑的手术策略在实际应用中导致更低的翻修率。
