Preoperative Radiographic Predictors of Subsequent Fusion After Lumbar Decompression Surgery.

IF 2.6 2区医学 Q2 CLINICAL NEUROLOGY

Spine Pub Date : 2024-11-15 Epub Date: 2024-07-26 DOI:10.1097/BRS.0000000000005109

Mark J Lambrechts, Jeremy C Heard, Nicholas D D'Antonio, Yunsoo Lee, Rajkishen Narayanan, Teeto Ezeonu, Garrett Breyer, John Paulik, Sydney Somers, Anthony J Labarbiera, Jose A Canseco, Mark F Kurd, Ian D Kaye, Alan S Hilibrand, Alexander R Vaccaro, Gregory D Schroeder, Christopher K Kepler

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引用次数: 0

Abstract

Study design: Retrospective cohort study.

Objective: The purpose of this study is to determine which demographic, surgical, and radiographic preoperative characteristics are most associated with the need for subsequent fusion after decompression lumbar spinal surgery.

Summary of background data: There is a relatively high rate of the need for repeat decompression or fusion after an index decompression procedure for degenerative spine disease. Nevertheless, there is a dearth of literature identifying risk factors for lumbar fusion following decompression surgery.

Methods: Patients 18 years or older receiving a primary lumbar decompression surgery within the levels of L3-S1 between 2011 and 2020 were identified. All patients had preoperative radiographs and 2 years of follow-up data. Chart review was performed for surgical characteristics and demographics. The sagittal parameters included lumbar lordosis (LL), segmental lordosis (SL), anterior disk height (aDH), posterior disk height (pDH), sacral slope (SS), and pelvic tilt (PT). Pelvic incidence (PI=PT+SS) and pelvic incidence minus lumbar lordosis (PI-LL) were calculated. In addition, the Roussouly classification was determined for each patient. Bivariant and multivariant analyses were performed.

Results: Of the 363 patients identified in this study, 96 patients had a fusion after their index decompression surgery. Multivariable analysis identified involvement of L4-L5 level in the decompression [odds ratio (OR)=1.83 (1.09-3.14), P =0.026], increased L5-S1 segmental lordosis [OR=1.08 (1.03-1.13), P =0.001], decreased SS [OR=0.96 (0.93-0.99), P =0.023], and decreased endplate obliquity [OR=0.88 (0.77-0.99), P =0.040] as significant independent predictors of fusion after decompression surgery.

Conclusions: This is one of the first studies to assess preoperative sagittal parameters in conjunction with demographic variables to determine predictors of the need for fusion after index decompression. We demonstrated that decompression at L4-L5, greater L5-S1 segmental lordosis, decreased sacral slope, and decreased endplate obliquity were associated with higher rates of fusion after decompression surgery.

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腰椎减压术后后续融合的术前影像学预测因素

研究设计回顾性队列研究：本研究的目的是确定哪些人口统计学、手术和放射学术前特征与腰椎减压术后再次融合的需求最相关：背景数据摘要：在对退行性脊椎病进行指数减压术后，需要再次减压或融合的比例相对较高。然而，关于减压术后腰椎融合术风险因素的文献却很少：方法：对 2011 年至 2020 年间在 L3-S1 水平内接受初次腰椎减压手术的 18 岁或以上患者进行鉴定。所有患者均有术前X光片和2年的随访数据。对手术特征和人口统计学进行了病历审查。矢状面参数包括腰椎前凸（LL）、节段前凸（SL）、椎间盘前高（aDH）、椎间盘后高（pDH）、骶骨斜度（SS）和骨盆倾斜（PT）。计算骨盆入射角（PI=PT+SS）和骨盆入射角减去腰椎前凸（PI-LL）。此外，还确定了每位患者的 Roussouly 分级。进行了二变量和多变量分析：结果：在这项研究中确定的363名患者中，96名患者在指数减压手术后进行了融合。多变量分析确定了 L4-L5 水平参与减压（几率比 (OR)=1.83 (1.09-3.14)，P=0.026）、L5-S1 节段前凸增加（OR=1.08 (1.03-1.13)，P=0.001）、SS减少（OR=0.96 (0.93-0.99)，P=0.023）和终板斜度减少（OR=0.88 (0.77-0.99)，P=0.040）是减压手术后融合的显著独立预测因素：这是第一项结合人口统计学变量评估术前矢状面参数以确定指数减压术后是否需要融合的预测因素的研究。我们证实，L4-L5减压、L5-S1节段前凸增大、骶骨斜度减小和终板斜度减小与减压术后较高的融合率有关。

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

Spine 医学-临床神经学

CiteScore

5.90

自引率

6.70%

发文量

361

审稿时长

6.0 months

期刊介绍： Lippincott Williams & Wilkins is a leading international publisher of professional health information for physicians, nurses, specialized clinicians and students. For a complete listing of titles currently published by Lippincott Williams & Wilkins and detailed information about print, online, and other offerings, please visit the LWW Online Store. Recognized internationally as the leading journal in its field, Spine is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of Spine. It is the leading subspecialty journal for the treatment of spinal disorders. Only original papers are considered for publication with the understanding that they are contributed solely to Spine. The Journal does not publish articles reporting material that has been reported at length elsewhere.