Xin Xin, Ni Jiajun, Yan Shi, Yuan Lei, Chen Zhongqiang, Zeng Yan
Department of Orthopedics, Peking University Third Hospital, Beijing, China.
Beijing Key Laboratory of Spinal Disease Research, Beijing, China.
Orthop Surg. 2025 Sep;17(9):2579-2587. doi: 10.1111/os.70116. Epub 2025 Jul 21.
Numerous studies have reported the manifestations and influencing factors of poor matching of intervertebral fusion devices (IFDs) in patients with cervical and lumbar degenerative diseases. However, there is currently no research addressing the use of IFDs matching in posterior vertebral column resection (PVCR) procedures. The purpose of this retrospective radiographic study was to analyze the risk factors associated with poor matching of IFDs following PVCR.
Data from 92 patients using IFDs following PVCR between June 2006 and July 2024 were reviewed. IFDs implantation failure, adjacent vertebral fractures, subsidence greater than 5 mm, angle formation exceeding 10°, and malposition (defined as one-third of the IFDs exceeding the outer edge of the matching interface) were used as screening indicators to divide patients into poor matching and matching groups. Potential risk factors of poor matching were assessed through univariate and multivariate logistic regression analysis. The multiple regression model was evaluated by the area under the receiver operating characteristic curve (AUC).
Among the 92 patients, 37 (40.2%) experienced poor matching. Univariate logistic regression analysis revealed that the preoperative and postoperative sagittal Cobb angles, the angle between osteotomy surfaces, total instrumented vertebrae, the number of vertebrae resected, the height of IFDs, and the use of titanium mesh or artificial vertebral bodies were potential risk factors for poor matching. Backward stepwise multivariate logistic regression analysis indicated that the preoperative sagittal Cobb angle (OR = 1.053, p = 0.001), the angle between osteotomy surfaces (OR = 1.152, p = 0.003), and the height of IFDs (OR = 1.058, p = 0.033) were independent risk factors for poor matching. The overall predictive performance of this multiple regression model (AUC = 0.872) for poor matching was deemed satisfactory.
The use of IFDs in PVCR was associated with a high rate of immediate poor matching. The preoperative sagittal Cobb angle, the angle between osteotomy surfaces, and the height of IFDs are independent risk factors for poor matching.
众多研究报告了颈椎和腰椎退行性疾病患者椎间融合器（IFD）匹配不佳的表现及影响因素。然而，目前尚无关于后路脊柱切除术（PVCR）中IFD匹配使用情况的研究。本回顾性影像学研究的目的是分析PVCR术后IFD匹配不佳的相关危险因素。
回顾了2006年6月至2024年7月期间92例行PVCR术后使用IFD的患者的数据。将IFD植入失败、相邻椎体骨折、下沉超过5毫米、角度形成超过10°以及位置异常（定义为三分之一的IFD超出匹配界面外缘）作为筛选指标，将患者分为匹配不佳组和匹配组。通过单因素和多因素逻辑回归分析评估匹配不佳的潜在危险因素。采用受试者操作特征曲线（AUC）下面积评估多元回归模型。
92例患者中，37例（40.2%）出现匹配不佳。单因素逻辑回归分析显示，术前和术后矢状面Cobb角、截骨面之间的角度、固定椎体总数、切除椎体数量、IFD高度以及钛网或人工椎体的使用是匹配不佳的潜在危险因素。向后逐步多因素逻辑回归分析表明，术前矢状面Cobb角（OR = 1.053，p = 0.001）、截骨面之间的角度（OR = 1.152，p = 0.003）和IFD高度（OR = 1.058，p = 0.033）是匹配不佳的独立危险因素。该多元回归模型对匹配不佳的总体预测性能（AUC = 0.872）被认为是令人满意的。
PVCR中使用IFD与即刻匹配不佳的高发生率相关。术前矢状面Cobb角、截骨面之间的角度和IFD高度是匹配不佳的独立危险因素。
