{"title":"使用可扩展的固定器进行侧位腰椎椎体间融合时的节段性前凸和椎间盘高度差异。","authors":"Akihiko Hiyama, Daisuke Sakai, Hiroyuki Katoh, Masato Sato, Masahiko Watanabe","doi":"10.14444/8726","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>This study evaluated discrepancies between the expected intervertebral disc height (DH) and segmental lordosis (SL), defined as predicted values based on the rotations of the expandable cage driver, and the actual DH and SL achieved postoperatively in lateral lumbar interbody fusion (LLIF) using expandable cages.</p><p><strong>Methods: </strong>A retrospective review was conducted on patients who underwent LLIF with expandable cages between May 2022 and May 2024. The study included 51 patients (28 men and 23 women; mean age: 70.6 ± 11.7 years). Surgical outcomes measured included SL, anterior DH, posterior DH, average DH, canal diameter, and central canal area (CCA). Pre- and postoperative measurements were compared to evaluate cage effectiveness.</p><p><strong>Results: </strong>Postoperative measurements showed significant improvements: SL increased from 3.5° to 4.8° (<i>P</i> = 0.002), anterior DH from 5.9 to 10.7 mm (<i>P</i> < 0.001), PDH from 3.4 to 7.7 mm (<i>P</i> < 0.001), and average DH from 4.6 to 9.2 mm (<i>P</i> < 0.001). Despite these gains, the actual SL (4.8°) was significantly lower than the predicted SL (8.7°, <i>P</i> < 0.001). Canal dimensions also improved, with canal diameter increasing from 5.0 to 8.3 mm and CCA from 55.8 to 89.7 mm² (<i>P</i> < 0.001 for both). A significant correlation was found between changes in posterior DH and CCA (<i>r</i> = 0.272, <i>P</i> = 0.017).</p><p><strong>Conclusion: </strong>Expandable cages in LLIF significantly improved DH, SL, and canal dimensions, contributing to better clinical outcomes. However, achieving the ideal SL remains challenging, highlighting the need for further refinement in surgical techniques and cage design.</p><p><strong>Clinical relevance: </strong>Expandable cages in LLIF significantly enhance DH, SL, and spinal canal dimensions, which contribute to improved clinical outcomes such as pain relief and functional recovery. However, the difficulty in achieving the ideal SL suggests further advancements are needed in surgical techniques and cage design to optimize patient outcomes and long-term spinal alignment.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"188-199"},"PeriodicalIF":1.7000,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Segmental Lordosis and Disc Height Discrepancies in Lateral Lumbar Interbody Fusion Using Expandable Cages.\",\"authors\":\"Akihiko Hiyama, Daisuke Sakai, Hiroyuki Katoh, Masato Sato, Masahiko Watanabe\",\"doi\":\"10.14444/8726\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>This study evaluated discrepancies between the expected intervertebral disc height (DH) and segmental lordosis (SL), defined as predicted values based on the rotations of the expandable cage driver, and the actual DH and SL achieved postoperatively in lateral lumbar interbody fusion (LLIF) using expandable cages.</p><p><strong>Methods: </strong>A retrospective review was conducted on patients who underwent LLIF with expandable cages between May 2022 and May 2024. The study included 51 patients (28 men and 23 women; mean age: 70.6 ± 11.7 years). Surgical outcomes measured included SL, anterior DH, posterior DH, average DH, canal diameter, and central canal area (CCA). Pre- and postoperative measurements were compared to evaluate cage effectiveness.</p><p><strong>Results: </strong>Postoperative measurements showed significant improvements: SL increased from 3.5° to 4.8° (<i>P</i> = 0.002), anterior DH from 5.9 to 10.7 mm (<i>P</i> < 0.001), PDH from 3.4 to 7.7 mm (<i>P</i> < 0.001), and average DH from 4.6 to 9.2 mm (<i>P</i> < 0.001). Despite these gains, the actual SL (4.8°) was significantly lower than the predicted SL (8.7°, <i>P</i> < 0.001). Canal dimensions also improved, with canal diameter increasing from 5.0 to 8.3 mm and CCA from 55.8 to 89.7 mm² (<i>P</i> < 0.001 for both). A significant correlation was found between changes in posterior DH and CCA (<i>r</i> = 0.272, <i>P</i> = 0.017).</p><p><strong>Conclusion: </strong>Expandable cages in LLIF significantly improved DH, SL, and canal dimensions, contributing to better clinical outcomes. However, achieving the ideal SL remains challenging, highlighting the need for further refinement in surgical techniques and cage design.</p><p><strong>Clinical relevance: </strong>Expandable cages in LLIF significantly enhance DH, SL, and spinal canal dimensions, which contribute to improved clinical outcomes such as pain relief and functional recovery. However, the difficulty in achieving the ideal SL suggests further advancements are needed in surgical techniques and cage design to optimize patient outcomes and long-term spinal alignment.</p><p><strong>Level of evidence: 3: </strong></p>\",\"PeriodicalId\":38486,\"journal\":{\"name\":\"International Journal of Spine Surgery\",\"volume\":\" \",\"pages\":\"188-199\"},\"PeriodicalIF\":1.7000,\"publicationDate\":\"2025-05-12\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"International Journal of Spine Surgery\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.14444/8726\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Spine Surgery","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.14444/8726","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
摘要
背景：本研究评估了预期椎间盘高度（DH）和节段性前凸（SL）之间的差异，前者被定义为基于可伸缩笼驱动器旋转的预测值，后者与使用可伸缩笼进行侧位腰椎体间融合（LLIF）术后实现的实际DH和SL之间的差异。方法：回顾性分析2022年5月至2024年5月期间接受可扩笼LLIF治疗的患者。该研究包括51名患者(28名男性和23名女性；平均年龄：70.6±11.7岁)。测量手术结果包括SL、前DH、后DH、平均DH、管径和中央管面积（CCA）。比较术前和术后的测量结果来评估笼的有效性。结果：术后测量结果有明显改善：侧斜从3.5°增加到4.8°（P = 0.002），前侧偏从5.9 mm增加到10.7 mm (P < 0.001)， PDH从3.4 mm增加到7.7 mm (P < 0.001)，平均偏左从4.6 mm增加到9.2 mm （P < 0.001）。尽管有这些增益，但实际的SL（4.8°）明显低于预测的SL（8.7°，P < 0.001）。根管尺寸也有所改善，根管直径从5.0增加到8.3 mm， CCA从55.8增加到89.7 mm²（P < 0.001）。后DH与CCA变化有显著相关性（r = 0.272, P = 0.017）。结论：LLIF中可膨胀笼可显著改善DH、SL和管径，有助于改善临床效果。然而，实现理想的SL仍然具有挑战性，需要进一步改进手术技术和保持器设计。临床相关性：LLIF中的可扩展笼可显著提高DH、SL和椎管尺寸，有助于改善临床结果，如疼痛缓解和功能恢复。然而，实现理想的椎体后倾的困难表明，需要进一步改进手术技术和椎笼设计，以优化患者的预后和长期脊柱对齐。证据等级：3；
Segmental Lordosis and Disc Height Discrepancies in Lateral Lumbar Interbody Fusion Using Expandable Cages.
Background: This study evaluated discrepancies between the expected intervertebral disc height (DH) and segmental lordosis (SL), defined as predicted values based on the rotations of the expandable cage driver, and the actual DH and SL achieved postoperatively in lateral lumbar interbody fusion (LLIF) using expandable cages.
Methods: A retrospective review was conducted on patients who underwent LLIF with expandable cages between May 2022 and May 2024. The study included 51 patients (28 men and 23 women; mean age: 70.6 ± 11.7 years). Surgical outcomes measured included SL, anterior DH, posterior DH, average DH, canal diameter, and central canal area (CCA). Pre- and postoperative measurements were compared to evaluate cage effectiveness.
Results: Postoperative measurements showed significant improvements: SL increased from 3.5° to 4.8° (P = 0.002), anterior DH from 5.9 to 10.7 mm (P < 0.001), PDH from 3.4 to 7.7 mm (P < 0.001), and average DH from 4.6 to 9.2 mm (P < 0.001). Despite these gains, the actual SL (4.8°) was significantly lower than the predicted SL (8.7°, P < 0.001). Canal dimensions also improved, with canal diameter increasing from 5.0 to 8.3 mm and CCA from 55.8 to 89.7 mm² (P < 0.001 for both). A significant correlation was found between changes in posterior DH and CCA (r = 0.272, P = 0.017).
Conclusion: Expandable cages in LLIF significantly improved DH, SL, and canal dimensions, contributing to better clinical outcomes. However, achieving the ideal SL remains challenging, highlighting the need for further refinement in surgical techniques and cage design.
Clinical relevance: Expandable cages in LLIF significantly enhance DH, SL, and spinal canal dimensions, which contribute to improved clinical outcomes such as pain relief and functional recovery. However, the difficulty in achieving the ideal SL suggests further advancements are needed in surgical techniques and cage design to optimize patient outcomes and long-term spinal alignment.
期刊介绍：
The International Journal of Spine Surgery is the official scientific journal of ISASS, the International Intradiscal Therapy Society, the Pittsburgh Spine Summit, and the Büttner-Janz Spinefoundation, and is an official partner of the Southern Neurosurgical Society. The goal of the International Journal of Spine Surgery is to promote and disseminate online the most up-to-date scientific and clinical research into innovations in motion preservation and new spinal surgery technology, including basic science, biologics, and tissue engineering. The Journal is dedicated to educating spine surgeons worldwide by reporting on the scientific basis, indications, surgical techniques, complications, outcomes, and follow-up data for promising spinal procedures.
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