Hiranaka Yoshiaki, Miyazaki Shingo, Kuroshima Kohei, Ryu Masao, Inoue Shinichi, Yurube Takashi, Kakutani Kenichiro, Tadokoro Ko
Department of Orthopaedic Surgery, Anshin Hospital, Kobe, Japan.
Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Spine Surg Relat Res. 2025 Feb 7;9(4):443-452. doi: 10.22603/ssrr.2024-0285. eCollection 2025 Jul 27.
Some cases of postoperative correction loss have been observed in the reduction of vertebral slippage using a percutaneous pedicle screw system for lumbar degenerative spondylolisthesis. We aimed to identify the risk factors for correction loss after minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and to determine the effect of postoperative correction loss on postoperative clinical outcomes.
In this retrospective study, a total of 111 patients (mean age 69.5 years, 37 men and 74 women) who underwent single-level MIS-TLIF with slippage reduction for lumbar degenerative spondylolisthesis and were followed up for >1 year were included in the study. The correction loss group (group L) included those with a correction loss of ≥3 mm between immediately after surgery and 1 year after surgery, and the correction maintenance group (group M) included those with a correction loss <3 mm. Demographic data, preoperative and postoperative radiographic measurements, and clinical outcomes were collected, and the risk factors in group L and clinical outcomes in the two groups were analyzed statistically.
Groups L and M comprised 19 and 92 cases, respectively. High pelvic incidence-lumbar lordosis (odds ratio [OR]: 1.16, 95% confidence interval [CI]: 1.07-1.25, p<0.001), high slip vertebra slope (OR: 1.22, 95% CI: 1.07-1.39, p<0.001), and ≥10° segmental angulation (OR: 15.00, 95% CI: 3.04-73.95, p=0.0022) were risk factors for correction loss; however, low bone density was not. The Oswestry Disability Index and Visual Analog Scale scores for low back pain, leg pain, and leg numbness were not significantly different between both groups; however, the bone union rate at 6 months postoperatively was significantly lower in group L (p=0.0020).
Postoperative correction loss was influenced by preoperative sagittal alignment and instability rather than bone density. Patients with correction loss tend to have prolonged bone union and should be closely monitored.
在使用经皮椎弓根螺钉系统治疗腰椎退行性椎体滑脱症时，已观察到一些术后矫正丢失的病例。我们旨在确定微创经椎间孔腰椎椎间融合术（MIS-TLIF）后矫正丢失的危险因素，并确定术后矫正丢失对术后临床结果的影响。
在这项回顾性研究中，共有111例患者（平均年龄69.5岁，男性37例，女性74例）纳入研究，这些患者因腰椎退行性椎体滑脱症接受了单节段MIS-TLIF并伴有滑脱复位，且随访时间超过1年。矫正丢失组（L组）包括术后即刻与术后1年之间矫正丢失≥3mm的患者，矫正维持组（M组）包括矫正丢失<3mm的患者。收集人口统计学数据、术前和术后影像学测量数据以及临床结果，并对L组的危险因素和两组的临床结果进行统计学分析。
L组和M组分别包括19例和92例患者。高骨盆倾斜度-腰椎前凸（优势比[OR]：1.16，95%置信区间[CI]：1.07-1.25，p<0.001）、高滑脱椎体倾斜度（OR：1.22，95%CI：1.07-1.39，p<0.001）和≥10°节段性成角（OR：15.00，95%CI：3.04-73.95，p=0.0022）是矫正丢失的危险因素；然而，低骨密度不是。两组之间的Oswestry功能障碍指数以及腰痛、腿痛和腿部麻木的视觉模拟量表评分无显著差异；然而，L组术后6个月的骨愈合率显著较低（p=0.0020）。
术后矫正丢失受术前矢状面排列和不稳定性的影响，而非骨密度。矫正丢失的患者往往骨愈合时间延长，应密切监测。
