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使用可扩张椎间融合器的微创胸腰椎外侧椎间融合术治疗脊柱创伤——适应证、并发症及疗效

Minimally Invasive Lateral Thoracic and Lumbar Interbody Fusion with Expandable Interbody Spacers for Spine Trauma-Indications, Complications and Outcomes.

作者信息

Bättig Linda, Fischer Gregor, Martens Benjamin, Veeravagu Anand, Bertulli Lorenzo, Stienen Martin N

机构信息

Spine Center of Eastern Switzerland, Cantonal Hospital of St. Gallen & Medical School of St. Gallen, 9000 St. Gallen, Switzerland.

Department of Neurosurgery, Cantonal Hospital of St. Gallen & Medical School of St. Gallen, 9000 St. Gallen, Switzerland.

出版信息

J Clin Med. 2025 Jun 27;14(13):4557. doi: 10.3390/jcm14134557.

Abstract

: Lateral lumbar or thoracic interbody fusion (LLIF) is increasingly considered for anterior column reconstruction and restoring segmental lordosis in degenerative, infectious, or deformity conditions. Reports about using LLIF with expandable interbody spacers for spine trauma are scarce. : In this retrospective, single-center observational cohort study, we reviewed all patients treated by an expandable LLIF interbody spacer (ELSA Expandable Integrated LLIF Spacer, Globus Medical Inc) for trauma indication at our spine center between September 2018 and January 2024. The primary outcome measures were fusion rate at 12 months, change in segmental sagittal Cobb angle, and clinical outcome according to the MacNab criteria. Secondary outcomes included adverse events and complications. : We identified = 21 patients with a mean age of 48.3 (standard deviation (SD) 15.7), 47.6% were female. LLIF was mostly performed at T11/12 ( = 4; 19.1%) and T12/L1 ( = 10; 47.5%). Indications were AO Spine type A2 ( = 4, 19.1%), A3 ( = 14; 66.7%) or A4 fractures ( = 3; 14.3%) with ligamentous (B2-type) in eight (38.1%) and hyperextension (B3-type) injury in one patient (4.8%). Surgery included the release of the anterior longitudinal ligament in four cases (19.1%). Intraoperative AEs were noted in = 1 (4.8%), postoperative AEs in = 3 (14.3%) at discharge, = 4 (19.1%) at three, and = 2 (9.5%) at twelve months. Segmental sagittal Cobb angle changed from 1.3° (preoperative) to 13.3° at twelve months ( < 0.001). Functional outcome was excellent/good in = 15 (71.4%; four missing) at 12 months. The fusion rate at the LLIF level was 100% at the 12-month follow-up. : LLIF with expandable interbody spacers for spine trauma (off-label use) is safe, promotes solid fusion (100% fusion rate at 12 months), and enables correction of sagittal segmental Cobb angle (mean improvement of 12°), with good or excellent clinical outcomes in most patients (71.4%).

摘要

腰椎或胸椎侧方椎间融合术(LLIF)越来越多地被用于退行性、感染性或畸形性疾病的前柱重建和恢复节段性前凸。关于使用可扩张椎间融合器进行LLIF治疗脊柱创伤的报道很少。:在这项回顾性、单中心观察性队列研究中,我们回顾了2018年9月至2024年1月期间在我们脊柱中心接受可扩张LLIF椎间融合器(ELSA可扩张一体化LLIF融合器,Globus Medical公司)治疗创伤指征的所有患者。主要结局指标为12个月时的融合率、节段矢状面Cobb角变化以及根据MacNab标准评估的临床结局。次要结局包括不良事件和并发症。:我们确定了21例患者,平均年龄48.3岁(标准差[SD]15.7),47.6%为女性。LLIF大多在T11/12(4例;19.1%)和T12/L1(10例;47.5%)进行。指征为AO脊柱分型A2(4例,19.1%)、A3(14例;66.7%)或A4骨折(3例;14.3%),其中8例(38.1%)伴有韧带损伤(B2型),1例患者(4.8%)伴有过伸损伤(B3型)。4例(19.1%)手术包括松解前纵韧带。术中不良事件1例(4.8%),出院时术后不良事件3例(14.3%),3个月时4例(19.1%),12个月时2例(9.5%)。节段矢状面Cobb角从术前的1.3°在12个月时变为13.3°(P<0.001)。12个月时功能结局为优/良的有15例(71.4%;4例失访)。LLIF节段在12个月随访时融合率为100%。:使用可扩张椎间融合器进行LLIF治疗脊柱创伤(非适应证使用)是安全的,能促进牢固融合(12个月时融合率100%),并能矫正矢状节段Cobb角(平均改善12°),大多数患者(71.4%)临床结局良好或优秀。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2287/12249799/e76d8e5a2e33/jcm-14-04557-g001.jpg

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