Segmental and overall lumbar lordosis after single-level minimally invasive transforaminal lumbar interbody fusion: a systematic review and meta-analysis.

IF 2.9 2区 医学 Q2 CLINICAL NEUROLOGY
Justin K Zhang, Salim Yakdan, Saksham Pruthi, Muhammad I Kaleem, Nishtha Chavda, Jiaxi Lu, Kazimir Bagdady, Luke Wegenka, Tom Koch, Matthew ReVeal, Ying Liu, Christopher F Dibble, Jacob K Greenberg, Saad Javeed, Forrest A Hamrick, Spencer Twitchell, Ken Porche, Nicholas T Gamboa, Brandon A Sherrod, Mark A Mahan, Erica F Bisson, Andrew T Dailey, Marcus D Mazur, Wilson Z Ray
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引用次数: 0

Abstract

Objective: Because of heterogeneity in previous studies, the effect of minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) on postoperative segmental lordosis (SL) and lumbar lordosis (LL) remains unclear. Given this evidence gap, the authors performed a systematic review and meta-analysis of studies reporting lordotic outcomes after single-level MI-TLIF. The authors also performed a meta-regression to identify preoperative factors associated with lordosis after surgery and assessed correlations between lordotic changes and patient-reported outcomes.

Methods: In this systematic review, PubMed, Medline, CENTRAL, EMBASE, and Scopus were searched for studies describing single-level MI-TLIF for degenerative lumbar etiologies with at least 10 patients. Random-effects meta-analysis was used for data synthesis and I2 was used to assess heterogeneity. Primary outcomes were changes in SL and/or changes in overall LL.

Results: Thirty-five studies comprising 1935 patients were included: 23 (66%) retrospective case series, 9 (26%) retrospective, and 3 (9%) prospective cohort studies. Twenty-five (71%) studies evaluated static interbody devices, 5 (14%) expandable devices, and 5 (14%) both device types. Thirty (86%) studies used bilateral pedicle screw fixation, 2 (6%) used unilateral screw fixation, and 3 (9%) included both techniques. The mean (range) sample size was 55 (13-171) patients, mean ± SD age was 59.5 ± 10.6 years, mean ± SD BMI was 26.9 ± 4.6 kg/m2, and mean ± SD (range) length of follow-up was 21.4 ± 4.3 (6.0-63.7) months. On random-effects modeling, patients experienced a significant increase in SL (standardized mean difference [SMD] +2.2°, 95% CI 1.3°-3.1°, p < 0.001) and overall LL (SMD +2.8°, 95% CI 0.8°-4.8°, p < 0.001) at the latest follow-up. On meta-regression, preoperative SL (β = -0.24°, 95% CI -0.42° to -0.05°, p = 0.01) was predictive of a change in SL, whereas preoperative LL (β = -0.53°, 95% CI -0.81° to -0.25°, p = 0.009) and use of an expandable cage (β = 6.56°, 95% CI 1.0°-12.2°, p = 0.02) were predictive of a change in LL. Univariable meta-regression found that greater increases in SL were associated with larger reductions in postoperative leg pain (β = -1.03, 95% CI -1.6 to -0.45, p = 0.003); however, no significant associations were detected between changes in SL or LL and other clinical outcomes in either univariable or multivariable analyses.

Conclusions: Despite the significant heterogeneity among the included studies, these results suggest that single-level MI-TLIF is generally lordosis preserving, with preoperative alignment and interbody device type as possible predictors of postoperative lordosis.

单节段微创经椎间孔腰椎椎间融合术后的节段性和全身性腰椎前凸:一项系统回顾和荟萃分析。
目的:由于以往研究的异质性,微创经椎间孔腰椎椎体间融合术(MI-TLIF)对术后节段性前凸(SL)和腰椎前凸(LL)的影响尚不清楚。鉴于这一证据差距,作者对报告单级MI-TLIF后前凸结局的研究进行了系统回顾和荟萃分析。作者还进行了meta回归,以确定术前与手术后前凸相关的因素,并评估前凸变化与患者报告结果之间的相关性。方法:在本系统综述中,检索了PubMed、Medline、CENTRAL、EMBASE和Scopus,检索了描述至少10例腰椎退行性病因的单级MI-TLIF的研究。随机效应荟萃分析用于数据综合,I2用于评估异质性。主要结局是SL的改变和/或总体LL的改变。结果:35项研究纳入1935例患者:23项(66%)回顾性病例系列研究,9项(26%)回顾性研究,3项(9%)前瞻性队列研究。25项研究(71%)评估了静态体间装置,5项(14%)评估了可扩展装置,5项(14%)评估了两种装置类型。30例(86%)采用双侧椎弓根螺钉固定,2例(6%)采用单侧螺钉固定,3例(9%)采用两种技术。平均(范围)样本量55例(13 ~ 171例),平均±SD年龄59.5±10.6岁,平均±SD BMI 26.9±4.6 kg/m2,平均±SD(范围)随访时间21.4±4.3(6.0 ~ 63.7)个月。在随机效应模型中,在最近的随访中,患者的SL(标准化平均差[SMD] +2.2°,95% CI 1.3°-3.1°,p < 0.001)和总体LL (SMD +2.8°,95% CI 0.8°-4.8°,p < 0.001)显著增加。在meta回归中,术前SL (β = -0.24°,95% CI -0.42°至-0.05°,p = 0.01)可预测SL的变化,而术前LL (β = -0.53°,95% CI -0.81°至-0.25°,p = 0.009)和使用可膨胀笼(β = 6.56°,95% CI 1.0°至12.2°,p = 0.02)可预测SL的变化。单变量meta回归发现,SL增加越多,术后腿部疼痛减少越多(β = -1.03, 95% CI -1.6 ~ -0.45, p = 0.003);然而,在单变量或多变量分析中,没有发现SL或LL的变化与其他临床结果之间的显著关联。结论:尽管纳入的研究存在显著的异质性,但这些结果表明,单节段MI-TLIF通常能保持前凸,术前对准和椎间装置类型可能是术后前凸的预测因素。
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来源期刊
Journal of neurosurgery. Spine
Journal of neurosurgery. Spine 医学-临床神经学
CiteScore
5.10
自引率
10.70%
发文量
396
审稿时长
6 months
期刊介绍: Primarily publish original works in neurosurgery but also include studies in clinical neurophysiology, organic neurology, ophthalmology, radiology, pathology, and molecular biology.
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