经椎间孔腰椎椎间融合器下沉:对发生率、相关风险因素和对疗效影响的计算机断层扫描分析。

IF 2.9 2区 医学 Q2 CLINICAL NEUROLOGY
Journal of neurosurgery. Spine Pub Date : 2024-07-05 Print Date: 2024-10-01 DOI:10.3171/2024.4.SPINE231007
Hannah A Levy, Zachariah W Pinter, Ryder Reed, Joshua R Harmer, Kay Raftery, Karim Rizwan Nathani, Konstantinos Katsos, Mohamad Bydon, Jeremy L Fogelson, Benjamin D Elder, Bradford L Currier, Nicolas Newell, Ahmad N Nassr, Brett A Freedman, Brian A Karamian, Arjun S Sebastian
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引用次数: 0

摘要

研究目的本研究的目的是:1)确定经椎间孔腰椎椎体间融合术(TLIF)椎体间下沉的发生率;2)使用基于CT的评估确定术前、术中患者和器械特异性风险因素预测术后下沉的相对重要性;3)确定TLIF下沉对术后并发症和融合率的影响:回顾性鉴定2017年至2019年期间在一家多机构学术中心接受一或两级TLIF治疗腰椎退行性病变的所有成年患者。排除了有外伤、感染、恶性肿瘤、曾在指数水平进行过融合术、前后联合手术、手术超过两个 TLIF 水平或随访不完全的患者。在术后 6 个月以上的冠状和矢状 CT 扫描中,直接测量每个 TLIF 水平的上内板和下内板的椎间隙下沉情况。根据先前记录的< 2毫米、2至4毫米和≥ 4毫米阈值,将患者按每个手术水平的最大下沉分为轻度、中度和重度。单变量分析和回归分析比较了不同下沉组的患者人口统计学特征、合并症、术前骨质、手术因素(包括椎间笼参数)、融合率和并发症发生率:共有67名患者的85个融合层次符合纳入和排除标准。总体而言,TLIF术后28%的水平表现为中度下沉,35%的水平表现为重度下沉,上、下终板下沉无明显差异。中度(≥ 2-mm)和重度(≥ 4-mm)下沉与椎体笼表面积和 Taillard 指数的下降以及聚醚醚酮(PEEK)材料和锯齿表面几何形状的椎体间架显著相关。严重下沉与术前椎间盘间隙增高、椎体霍恩斯菲尔德单位(HU)降低、未使用骨形态发生蛋白(BMP)以及保持架表面光滑也有明显关系。回归分析表明,Taillard指数、保持架表面积和HU的下降以及未使用BMP都预示着下沉。严重下沉是假关节的一个预测因素,但与翻修手术无明显关联:结论:患者水平的TLIF下沉风险因素包括HU降低和术前椎间盘高度增加。TLIF下沉的术中风险因素包括保持架表面积减少、PEEK保持架材料、子弹头保持架、保持架后方定位、保持架表面光滑和锯齿表面设计。严重下沉预示着 TLIF 假关节的发生,但这种关系的因果关系仍不清楚。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Transforaminal lumbar interbody fusion subsidence: computed tomography analysis of incidence, associated risk factors, and impact on outcomes.

Objective: The aims of this study were to 1) define the incidence of transforaminal lumbar interbody fusion (TLIF) interbody subsidence; 2) determine the relative importance of preoperative and intraoperative patient- and instrumentation-specific risk factors predictive of postoperative subsidence using CT-based assessment; and 3) determine the impact of TLIF subsidence on postoperative complications and fusion rates.

Methods: All adult patients who underwent one- or two-level TLIF for lumbar degenerative conditions at a multi-institutional academic center between 2017 and 2019 were retrospectively identified. Patients with traumatic injury, infection, malignancy, previous fusion at the index level, combined anterior-posterior procedures, surgery with greater than two TLIF levels, or incomplete follow-up were excluded. Interbody subsidence at the superior and inferior endplates of each TLIF level was directly measured on the endplate-facing surface of both coronal and sagittal CT scans obtained greater than 6 months postoperatively. Patients were grouped based on the maximum subsidence at each operative level classified as mild, moderate, or severe based on previously documented < 2-mm, 2- to 4-mm, and ≥ 4-mm thresholds, respectively. Univariate and regression analyses compared patient demographics, medical comorbidities, preoperative bone quality, surgical factors including interbody cage parameters, and fusion and complication rates across subsidence groups.

Results: A total of 67 patients with 85 unique fusion levels met the inclusion and exclusion criteria. Overall, 28% of levels exhibited moderate subsidence and 35% showed severe subsidence after TLIF with no significant difference in the superior and inferior endplate subsidence. Moderate (≥ 2-mm) and severe (≥ 4-mm) subsidence were significantly associated with decreases in cage surface area and Taillard index as well as interbody cages with polyetheretherketone (PEEK) material and sawtooth surface geometry. Severe subsidence was also significantly associated with taller preoperative disc spaces, decreased vertebral Hounsfield units (HU), the absence of bone morphogenetic protein (BMP) use, and smooth cage surfaces. Regression analysis revealed decreases in Taillard index, cage surface area, and HU, and the absence of BMP use predicted subsidence. Severe subsidence was found to be a predictor of pseudarthrosis but was not significantly associated with revision surgery.

Conclusions: Patient-level risk factors for TLIF subsidence included decreased HU and increased preoperative disc height. Intraoperative risk factors for TLIF subsidence were decreased cage surface area, PEEK cage material, bullet cages, posterior cage positioning, smooth cage surfaces, and sawtooth surface designs. Severe subsidence predicted TLIF pseudarthrosis; however, the causality of this relationship remains unclear.

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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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