[Occurrence and risk factors of adjacent segment degeneration after early extreme lateral interbody fusion].

Q3 Medicine
Y Guo, W T Wan, H M Bian, C Chen, H Y Yang, D Zhao, Q Yang
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引用次数: 0

Abstract

Objectives: To investigate the incidence of adjacent segment degeneration (ASD) following extreme lateral interbody fusion (XLIF) and identify risk factors for early ASD after XLIF. Methods: A retrospective study was conducted, including patients diagnosed with lumbar spinal stenosis who underwent XLIF at Tianjin Hospital between July 2019 and December 2022 and were followed-up for at least one year. Preoperative and final follow-up lumbar MRI and X-ray examination were performed for all patients to evaluate the degeneration status of adjacent segments. According to the occurrence of ASD at the last follow-up, the patients were divided into non-ASD group and ASD group. Age, gender, age, body mass index (BMI), American Society of Anesthesiologists (ASA) grade of anesthesia, follow-up time, length of fusion, time of operation, blood loss, hospital stay, pre-operation and follow-up clinical effects scores, pre-operation and follow-up sagittal parameters, central canal stenosis grades of adjacent segment and Pfirrmann grades were analyzed and compared between the two groups. Variables with a P-value less than 0.1 in the intergroup comparisons were included in a multivariate regression analysis to identify the risk factors for early onset of ASD following XLIF. Results: A total of 68 patients were included in this study, including 20 males and 48 females with a mean age of (60.0±6.9) years. At the last follow-up, 20 cases (28.9%) developed ASD and were included in the ASD group, while the remaining 48 cases were included in the non-ASD group. There was no statistically significant differences in the demographic characteristics between the two groups of patients (all P>0.05), indicating comparability. Compared with those in ASD group, the preoperative lumbar lordosis angle (LL) (46.5°±12.0° vs 32.3°±15.9°, P<0.01) and the sacral slope angle (SS) (36.6°±7.1° vs 29.5°±12.6°, P=0.022) in the non-ASD group were both greater, the mismatch rate of the preoperative pelvic incidence-lumbar lordosis angle (PI-LL) was lower [25.0% (12/48) vs 60.0% (12/20), P=0.033], and the preoperative morphologic grading of adjacent segmental vertebral canals was better (grades 0/1 were 33/15 and 6/14 cases, respectively, P<0.01). Compared to preoperative values, both groups showed significant improvements in the Oswestry disability index (ODI) score, VAS (back), and VAS (leg) at the last follow-up (all P<0.01). However, there were no statistically significant differences in the preoperative clinical function scores and the clinical function improvement rates at the last follow-up between the two groups (all P>0.05). Multivariate analysis showed that the preoperative central canal stenosis grade 1 of adjacent segment was a risk factor for ASD after early XLIF (OR=13.00, 95%CI: 2.51-67.04, P<0.01). Conclusions: About 28.9% of patients may experience ASD one year after XLIF surgery, preoperative adjacent segment central canal stenosis grade 1 is a risk factor for early postoperative ASD after XLIF surgery.

[早期极外侧椎体间融合术后邻近节段退化的发生率和风险因素]。
目的:探讨极外侧椎体间融合(XLIF)术后邻段退变(ASD)的发生率,并探讨XLIF术后早期ASD的危险因素。方法:回顾性研究纳入2019年7月至2022年12月在天津医院行腰椎管狭窄行XLIF的患者,随访至少1年。术前和最后随访时对所有患者进行腰椎MRI和x线检查,以评估邻近节段的退变情况。根据末次随访时ASD的发生情况将患者分为非ASD组和ASD组。分析比较两组患者的年龄、性别、年龄、体重指数(BMI)、美国麻醉医师学会(ASA)麻醉分级、随访时间、融合时间、手术时间、出血量、住院时间、术前及随访临床效果评分、术前及随访矢状面参数、中心管邻近节段狭窄分级及Pfirrmann分级。将组间比较p值小于0.1的变量纳入多元回归分析,以确定XLIF后早发ASD的危险因素。结果:本研究共纳入68例患者,其中男性20例,女性48例,平均年龄(60.0±6.9)岁。末次随访时,20例(28.9%)发展为ASD,被纳入ASD组,其余48例被纳入非ASD组。两组患者人口学特征差异无统计学意义(P < 0.05),具有可比性。与ASD组相比,非ASD组术前腰椎前凸角(LL)(46.5°±12.0°vs 32.3°±15.9°,PP=0.022)均较大,术前骨盆发生率-腰椎前凸角(PI-LL)不匹配率较低[25.0% (12/48)vs 60.0% (12/20), P=0.033],术前相邻节段椎管形态学分级较好(0/1级分别为33/15和6/14例,PPP>0.05)。多因素分析显示,术前邻近节段中央管狭窄1级是早期XLIF术后ASD的危险因素(OR=13.00, 95%CI: 2.51-67.04, p)。结论:约28.9%的患者在XLIF术后1年可能发生ASD,术前邻近节段中央管狭窄1级是XLIF术后早期ASD的危险因素。
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
Zhonghua yi xue za zhi
Zhonghua yi xue za zhi Medicine-Medicine (all)
CiteScore
0.80
自引率
0.00%
发文量
400
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