Incidence Rates and Risks for Reoperations for Nonunion and Adjacent Level Disease: Stopping at L1 versus T10/T11/12.

IF 2.6 2区医学 Q2 CLINICAL NEUROLOGY

Spine Pub Date : 2025-01-22 DOI:10.1097/BRS.0000000000005257

Kern H Guppy, Richard Chang, Jacob Fennessy, Heather A Prentice, Jessica E Harris, Allen L Ho, Amir Goodarzi Babhadi, Harsimran S Brara, Calvin Kuo

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引用次数: 0

Abstract

Study design: A retrospective cohort study.

Objective: To determine if there is a difference in reoperations for adjacent segment disease (operative ASD) and nonunion (operative nonunion) in lumbar fusions that stop at T10/T11/T12 versus L1.

Summary of background data: Current lumbar spine surgery is based on the belief that ASD occurs if fusions are stopped at L1 although there is varying evidence to support this assumption.

Methods: We conducted a cohort study using data from a US-based integrated healthcare system's Spine Registry of adult patients ≥18 years old with degenerative disc disease/adult lumbar deformity who underwent primary lumbar fusions. The exposure of interest was lumbar fusions stopping at L1 versus T10/T11/T12. Propensity score-weighted Cox proportional hazards regressions were used to evaluate reoperation risk for ASD and for nonunion.

Results: The study cohort included 227 lumbar fusions that stop at L1 and 228 stop at T10/T11/12. Mean age for the cohort was 68.4 years with mean follow-up time of 6.3 years. For caudal level at L5 and S1, we found no statistical differences between operative ASD stopping at L1 versus T10/11/12 (HR=1.03, 95% CI=0.53-2.02, P=0.93 and HR=0.67, 95% CI=0.27-1.67, P=0.39, respectively). For the Short-segment fusions (caudal level: L3,4,5) and Long-segment fusions (L5, S1. S1+ilium) we also found no statistical difference in operative ASD (HR=1.44, 95% CI=0.68-3.09, P=0.34 and HR=0.83, 95% CI=0.52-1.30, P=0.41, respectively). For Long-segment fusions we also found no statistical difference in operative nonunion (HR=0.65, 95% CI=0.20-2.11, P=0.47).

Conclusion: Our study provides some evidence against crossing the thoracolumbar junction (TLJ) for individual constructs terminating at S1, as well as for Long-segment fusions, based on comparisons of operative ASD and operative nonunion. However, further research is needed to determine whether this finding holds true for individual constructs with caudal levels at L2, L3, L4, and S1+ilium.

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骨不连和邻近水平疾病再手术的发生率和风险：止于L1与T10/T11/12

研究设计：回顾性队列研究。目的：确定邻近节段疾病（手术性ASD）和腰椎融合术止于T10/T11/T12与L1的不愈合（手术性不愈合）的再手术是否存在差异。背景资料总结：目前的腰椎手术是基于这样一种观点，即如果融合在L1处停止，就会发生ASD，尽管有不同的证据支持这一假设。方法：我们进行了一项队列研究，使用来自美国综合医疗保健系统脊柱登记处的数据，研究对象为≥18岁的退行性椎间盘疾病/成人腰椎畸形患者，他们接受了原发性腰椎融合术。暴露感兴趣的是腰椎融合停止在L1与T10/T11/T12。使用倾向评分加权Cox比例风险回归来评估ASD和不愈合的再手术风险。结果：研究队列包括227例腰椎融合，分别在L1和T10/T11/12处停止。该队列的平均年龄为68.4岁，平均随访时间为6.3年。对于L5和S1的尾侧水平，我们发现手术ASD在L1与T10/11/12之间无统计学差异（HR=1.03, 95% CI=0.53-2.02， P=0.93； HR=0.67, 95% CI=0.27-1.67， P=0.39）。对于短节段融合（尾节段：L3,4,5）和长节段融合（L5, S1）。S1+髂骨)，术中ASD差异无统计学意义（HR=1.44, 95% CI=0.68 ~ 3.09， P=0.34； HR=0.83, 95% CI=0.52 ~ 1.30， P=0.41）。对于长段融合，我们也发现手术不愈合无统计学差异（HR=0.65, 95% CI=0.20-2.11， P=0.47）。结论：通过对手术ASD和手术不愈合的比较，我们的研究提供了一些证据，表明在S1处终止的个体结构和长节段融合中不需要穿过胸腰段连接（TLJ）。然而，需要进一步的研究来确定这一发现是否适用于L2、L3、L4和S1+髂骨的尾侧水平的个体结构。

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

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