Soh Jaewan, Roh Young-Ho, Lee Jae Chul, Kim Dae Woong, Shin Byung-Joon
Hanyang University Guri Hospital, Guri-si, Korea, Republic of.
Jeju National University Hospital, Jeju City, Korea, Republic of.
Eur Spine J. 2025 Aug 12. doi: 10.1007/s00586-025-09227-8.
PURPOSE: To identify factors contributing to spontaneous facet fusion (SFF) after lateral lumbar interbody fusion (LLIF) with percutaneous pedicle screw fixation and evaluate its clinical significance. METHODS: We analyzed 43 patients (150 facet joints) who underwent LLIF with percutaneous pedicle screw fixation without posterior decompression and had at least one year of follow-up. Factors associated with SFF included patient-related factors (age, BMI, diabetes, smoking, osteoporosis), lumbar spinal factors (preoperative diagnosis, number of fused segments), and radiologic factors (facet osteoarthritis, interbody fusion status, cage position, and subsidence). Clinical outcomes were assessed using VAS for lower back pain (LBP) and radiating pain (RP) and the Oswestry Disability Index (ODI). Patients were categorized into three groups based on facet and interbody fusion status. RESULTS: SFF was observed in 65.3% (98/150) of facet joints, and in 52.0% of cases, SFF preceded interbody fusion. Preoperative facet osteoarthritis (p = 0.009, OR = 9.951) and solid interbody fusion (p = 0.048, OR = 9.837) were significant predictors of SFF. Clinical analysis showed significantly lower VAS for LBP in fused segments (p = 0.023), though no difference between facet fusion-only and interbody fusion groups. CONCLUSIONS: SFF frequently occurs after LLIF with percutaneous pedicle screw fixation, often before interbody fusion. It was more common in preoperative facet joint osteoarthritis and was frequently seen with solid interbody fusion. SFF correlates with improved LBP outcomes.
目的:确定在经皮椎弓根螺钉固定的腰椎侧方椎间融合术(LLIF)后促进小关节自发融合(SFF)的因素,并评估其临床意义。 方法:我们分析了43例(150个小关节)接受经皮椎弓根螺钉固定的LLIF且未行后路减压并至少随访1年的患者。与SFF相关的因素包括患者相关因素(年龄、体重指数、糖尿病、吸烟、骨质疏松症)、腰椎因素(术前诊断、融合节段数)和放射学因素(小关节骨关节炎、椎间融合状态、椎间融合器位置和下沉)。使用视觉模拟评分法(VAS)评估下腰痛(LBP)和放射痛(RP)以及Oswestry功能障碍指数(ODI)来评估临床结果。根据小关节和椎间融合状态将患者分为三组。 结果:在65.3%(98/150)的小关节中观察到SFF,在52.0%的病例中,SFF先于椎间融合出现。术前小关节骨关节炎(p = 0.009,OR = 9.951)和椎间融合牢固(p = 0.048,OR = 9.837)是SFF的显著预测因素。临床分析显示融合节段的LBP的VAS显著更低(p = 0.023),尽管仅小关节融合组和椎间融合组之间无差异。 结论:经皮椎弓根螺钉固定的LLIF术后经常发生SFF,通常在椎间融合之前。它在术前小关节骨关节炎中更常见,并且在椎间融合牢固时经常出现。SFF与LBP结果改善相关。
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