Long-term Outcomes After Adult Spinal Deformity Surgery Using Lateral Interbody Fusion: Short Versus Long Fusion.

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Spine Surgery Pub Date : 2024-10-01 Epub Date: 2024-02-16 DOI:10.1097/BSD.0000000000001583

Shunji Tsutsui, Hiroshi Hashizume, Hiroshi Iwasaki, Masanari Takami, Yuyu Ishimoto, Keiji Nagata, Hiroshi Yamada

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Abstract

Study design: Retrospective cohort study.

Objective: To investigate long-term outcomes after short or long fusion for adult spinal deformity using lateral interbody fusion.

Summary of background data: Lateral interbody fusion is commonly used in adult spinal deformity surgery. Favorable short-term outcomes have been reported, but not long-term outcomes. Lateral interbody fusion with strong ability to correct deformity may allow the selection of short fusion techniques.

Materials and methods: We retrospectively reviewed adults who underwent this surgery with a minimum of 5 years of follow-up. Short fusion with the uppermost instrumented vertebra in the lumbar spine was performed in patients without degenerative changes at the thoracolumbar junction (S-group); others underwent long fusion with the uppermost instrumented vertebra in the thoracic spine (L-group). We assessed radiographic and clinical outcomes.

Results: Short fusion was performed in 29 of 54 patients. One patient per group required revision surgery. Of the remainder, with similar preoperative characteristics and deformity correction between groups, correction loss (pelvic incidence-lumbar lordosis, P =0.003; pelvic tilt, P =0.005; sagittal vertical axis, P ˂0.001) occurred within 2 years postoperatively in the S-group, and sagittal vertical axis continued to increase until the 5-year follow-up ( P =0.021). Although there was a significant change in Oswestry disability index in the S-group ( P =0.031) and self-image of Scoliosis Research Society 22r score in both groups ( P =0.045 and 0.02) from 2- to 5-year follow-up, minimum clinically important differences were not reached. At 5-year follow-up, there was a significant difference in Oswestry Disability Index ( P =0.013) and Scoliosis Research Society 22r scores (function: P =0.028; pain: P =0.003; subtotal: P =0.006) between the groups, but satisfaction scores were comparable and Oswestry Disability Index score (29.8%) in the S-group indicated moderate disability.

Conclusions: Health-related quality of life was maintained between 2- and 5-year follow-up in both groups. Short fusion may be an option for patients without degenerative changes at the thoracolumbar junction.

Level of evidence: III.

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使用侧椎间融合术进行成人脊柱畸形手术后的长期疗效：短融合与长融合

研究设计回顾性队列研究：调查使用侧位椎体间融合术治疗成人脊柱畸形的短融合术或长融合术后的长期疗效：侧位椎体间融合术是成人脊柱畸形手术的常用方法。短期疗效良好，但长期疗效不佳。外侧椎体间融合术具有很强的矫正畸形能力，因此可以选择短融合技术：我们对接受过这种手术且至少随访 5 年的成人进行了回顾性研究。对胸腰椎交界处无退行性病变的患者（S 组）采用腰椎最上端的器械椎体短融合术；其他患者采用胸椎最上端的器械椎体长融合术（L 组）。我们对放射学和临床结果进行了评估：结果：54名患者中有29名接受了短融合术。每组有一名患者需要进行翻修手术。其余患者的术前特征和畸形矫正情况在各组之间相似，S组患者在术后2年内出现矫正损失（骨盆内陷-腰椎前凸，P=0.003；骨盆倾斜，P=0.005；矢状纵轴，P˂0.001），矢状纵轴在5年随访前持续增加（P=0.021）。虽然S组的Oswestry残疾指数（P=0.031）和脊柱侧弯研究学会22r自我形象评分（P=0.045和0.02）在2年至5年随访期间均有显著变化，但未达到最小临床重要差异。在5年的随访中，两组的Oswestry残疾指数（P=0.013）和脊柱侧弯研究协会22r评分（功能：P=0.028；疼痛：P=0.003；小计：P=0.006）有显著差异，但满意度评分相当，S组的Oswestry残疾指数评分（29.8%）显示为中度残疾：结论：两组患者的健康相关生活质量在2年和5年的随访期间均保持不变。对于胸腰椎交界处无退行性病变的患者来说，短融合术可能是一种选择：证据等级：III。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Spine Surgery Medicine-Surgery

CiteScore

3.00

自引率

5.30%

发文量

236

期刊介绍： Clinical Spine Surgery is the ideal journal for the busy practicing spine surgeon or trainee, as it is the only journal necessary to keep up to date with new clinical research and surgical techniques. Readers get to watch leaders in the field debate controversial topics in a new controversies section, and gain access to evidence-based reviews of important pathologies in the systematic reviews section. The journal features a surgical technique complete with a video, and a tips and tricks section that allows surgeons to review the important steps prior to a complex procedure. Clinical Spine Surgery provides readers with primary research studies, specifically level 1, 2 and 3 studies, ensuring that articles that may actually change a surgeon’s practice will be read and published. Each issue includes a brief article that will help a surgeon better understand the business of healthcare, as well as an article that will help a surgeon understand how to interpret increasingly complex research methodology. Clinical Spine Surgery is your single source for up-to-date, evidence-based recommendations for spine care.