Zach Pennington, Rahul Kumar, Abdelrahman Hamouda, Michael Martini, Anthony L Mikula, Maria Astudillo Potes, Mohamad Bydon, Michelle J Clarke, William E Krauss, Ahmad N Nassr, Brett A Freedman, Arjun S Sebastian, Jeremy L Fogelson, Benjamin D Elder
{"title":"1或2节段经椎间孔腰椎椎间融合术后植入物下沉预测因素的生存分析。","authors":"Zach Pennington, Rahul Kumar, Abdelrahman Hamouda, Michael Martini, Anthony L Mikula, Maria Astudillo Potes, Mohamad Bydon, Michelle J Clarke, William E Krauss, Ahmad N Nassr, Brett A Freedman, Arjun S Sebastian, Jeremy L Fogelson, Benjamin D Elder","doi":"10.3171/2025.1.SPINE24923","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Transforaminal lumbar interbody fusion (TLIF) offers both indirect decompression and segmental correction through restoration of disc height. However, stresses exerted on the vertebral endplates by the interbody device can result in implant subsidence and loss of correction. The present time-to-event analysis aimed to identify predictors of interbody subsidence.</p><p><strong>Methods: </strong>Patients who underwent 1- or 2-level TLIF were identified. Data on demographics, surgical details, preoperative bone quality using CT-based Hounsfield units (HU), and pre- and postoperative lumbopelvic parameters were collected. Univariable analyses were conducted to identify predictors of subsidence (≥ 2-mm intrusion of interbody into cranial or caudal vertebrae) and significant subsidence (≥ 4-mm intrusion). Multivariable Cox regression was performed to identify independent predictors of subsidence, expressed as hazard ratios with 95% confidence intervals.</p><p><strong>Results: </strong>A total of 198 patients treated at 241 levels were included (median age 66.6 years, IQR 59.5, 73.7 years; 56.6% were women). In 92 levels (38.2%) there was some subsidence and in 25 (10.4%) there was significant subsidence. Implanted levels demonstrating subsidence (≥ 2 mm) were associated with lower HU in cranial and caudal vertebrae; had interbodies positioned farther from the anterior apophyseal ring; were implanted with taller, more lordotic interbodies; and underwent greater disc height restoration. Those showing significant subsidence (≥ 4 mm) were similarly associated with lower HU in the cranial and caudal vertebrae; had interbodies positioned farther from the anterior apophyseal ring of the caudal vertebrae; and underwent greater disc height restoration. Multivariable Cox regression showed that time to subsidence was predicted by greater implant height (HR 1.20/mm, 95% CI 1.05-1.38; p = 0.009), greater postoperative disc height (HR 1.21/mm, 95% CI 1.09-1.34; p < 0.001), and greater disc height restoration (HR 1.11/mm, 95% CI 1.04-1.19; p = 0.002). The time-to-subsidence analysis for significant (≥ 4 mm) subsidence showed that it was predicted by lower HU in the cranial vertebrae (HR 0.98/unit, 95% CI 0.97-0.99; p = 0.001); increasing number of levels instrumented (HR 1.26, 95% CI 1.04-1.52; p = 0.016); and greater disc height restoration (HR 1.33/mm, 95% CI 1.18-1.51; p < 0.001).</p><p><strong>Conclusions: </strong>This time-to-event analysis suggests that interbody subsidence following TLIF is best predicted by implantation of a taller interbody and aggressive disc height restoration. Significant subsidence is similarly predicted by aggressive disc height restoration along with poor baseline bone quality. The results suggest the need to balance aggressive correction at the time of surgery against the increased risk of subsequent interbody subsidence.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-10"},"PeriodicalIF":2.9000,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"A survival analysis for predictors of implant subsidence following 1- or 2-level transforaminal lumbar interbody fusion.\",\"authors\":\"Zach Pennington, Rahul Kumar, Abdelrahman Hamouda, Michael Martini, Anthony L Mikula, Maria Astudillo Potes, Mohamad Bydon, Michelle J Clarke, William E Krauss, Ahmad N Nassr, Brett A Freedman, Arjun S Sebastian, Jeremy L Fogelson, Benjamin D Elder\",\"doi\":\"10.3171/2025.1.SPINE24923\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>Transforaminal lumbar interbody fusion (TLIF) offers both indirect decompression and segmental correction through restoration of disc height. However, stresses exerted on the vertebral endplates by the interbody device can result in implant subsidence and loss of correction. The present time-to-event analysis aimed to identify predictors of interbody subsidence.</p><p><strong>Methods: </strong>Patients who underwent 1- or 2-level TLIF were identified. Data on demographics, surgical details, preoperative bone quality using CT-based Hounsfield units (HU), and pre- and postoperative lumbopelvic parameters were collected. Univariable analyses were conducted to identify predictors of subsidence (≥ 2-mm intrusion of interbody into cranial or caudal vertebrae) and significant subsidence (≥ 4-mm intrusion). Multivariable Cox regression was performed to identify independent predictors of subsidence, expressed as hazard ratios with 95% confidence intervals.</p><p><strong>Results: </strong>A total of 198 patients treated at 241 levels were included (median age 66.6 years, IQR 59.5, 73.7 years; 56.6% were women). In 92 levels (38.2%) there was some subsidence and in 25 (10.4%) there was significant subsidence. Implanted levels demonstrating subsidence (≥ 2 mm) were associated with lower HU in cranial and caudal vertebrae; had interbodies positioned farther from the anterior apophyseal ring; were implanted with taller, more lordotic interbodies; and underwent greater disc height restoration. Those showing significant subsidence (≥ 4 mm) were similarly associated with lower HU in the cranial and caudal vertebrae; had interbodies positioned farther from the anterior apophyseal ring of the caudal vertebrae; and underwent greater disc height restoration. Multivariable Cox regression showed that time to subsidence was predicted by greater implant height (HR 1.20/mm, 95% CI 1.05-1.38; p = 0.009), greater postoperative disc height (HR 1.21/mm, 95% CI 1.09-1.34; p < 0.001), and greater disc height restoration (HR 1.11/mm, 95% CI 1.04-1.19; p = 0.002). The time-to-subsidence analysis for significant (≥ 4 mm) subsidence showed that it was predicted by lower HU in the cranial vertebrae (HR 0.98/unit, 95% CI 0.97-0.99; p = 0.001); increasing number of levels instrumented (HR 1.26, 95% CI 1.04-1.52; p = 0.016); and greater disc height restoration (HR 1.33/mm, 95% CI 1.18-1.51; p < 0.001).</p><p><strong>Conclusions: </strong>This time-to-event analysis suggests that interbody subsidence following TLIF is best predicted by implantation of a taller interbody and aggressive disc height restoration. Significant subsidence is similarly predicted by aggressive disc height restoration along with poor baseline bone quality. The results suggest the need to balance aggressive correction at the time of surgery against the increased risk of subsequent interbody subsidence.</p>\",\"PeriodicalId\":16562,\"journal\":{\"name\":\"Journal of neurosurgery. Spine\",\"volume\":\" \",\"pages\":\"1-10\"},\"PeriodicalIF\":2.9000,\"publicationDate\":\"2025-05-09\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of neurosurgery. Spine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.3171/2025.1.SPINE24923\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of neurosurgery. Spine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3171/2025.1.SPINE24923","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
目的:经椎间孔腰椎椎体间融合术(tliff)通过恢复椎间盘高度提供间接减压和节段性矫正。然而,椎体间装置对椎体终板施加的应力可导致植入物下沉和矫正丧失。目前的时间-事件分析旨在确定体间沉降的预测因素。方法:对1级或2级TLIF患者进行鉴定。统计数据、手术细节、术前骨质量(使用基于ct的Hounsfield单元(HU))以及术前和术后腰骨盆参数收集。进行单变量分析以确定沉降(体间侵入颅骨或尾椎≥2mm)和显著沉降(侵入≥4 mm)的预测因子。采用多变量Cox回归来确定沉降的独立预测因子,以95%置信区间的风险比表示。结果:共有198例患者接受241个级别的治疗(中位年龄66.6岁,IQR 59.5岁,73.7岁;56.6%为女性)。92处(38.2%)有一定的沉降,25处(10.4%)有明显的沉降。显示下沉(≥2mm)的植入水平与颅椎和尾椎较低的HU相关;间体离前突起环较远;植入较高、较前凸的间体;并接受了更大的椎间盘高度恢复。那些表现出明显下沉(≥4 mm)的患者与颅椎和尾椎的较低HU相似;椎体间距尾椎骨前棘环较远;并接受了更大的椎间盘高度恢复。多变量Cox回归分析显示,种植体高度越大,沉降时间越长(HR 1.20/mm, 95% CI 1.05-1.38;p = 0.009),术后椎间盘高度增大(HR 1.21/mm, 95% CI 1.09-1.34;p < 0.001),更大的椎间盘高度恢复(HR 1.11/mm, 95% CI 1.04-1.19;P = 0.002)。对显著沉降(≥4 mm)的时间分析表明,颅椎HU较低(HR 0.98/单位,95% CI 0.97-0.99;P = 0.001);增加检测水平(HR 1.26, 95% CI 1.04-1.52;P = 0.016);更大的椎间盘高度恢复(HR 1.33/mm, 95% CI 1.18-1.51;P < 0.001)。结论:该时间-事件分析表明,TLIF后体间沉降最好通过植入较高的体间和积极的椎间盘高度修复来预测。明显的下沉同样可以通过积极的椎间盘高度修复和较差的基线骨质量来预测。结果表明,需要在手术时进行积极的矫正,以防止随后的体间沉降风险增加。
A survival analysis for predictors of implant subsidence following 1- or 2-level transforaminal lumbar interbody fusion.
Objective: Transforaminal lumbar interbody fusion (TLIF) offers both indirect decompression and segmental correction through restoration of disc height. However, stresses exerted on the vertebral endplates by the interbody device can result in implant subsidence and loss of correction. The present time-to-event analysis aimed to identify predictors of interbody subsidence.
Methods: Patients who underwent 1- or 2-level TLIF were identified. Data on demographics, surgical details, preoperative bone quality using CT-based Hounsfield units (HU), and pre- and postoperative lumbopelvic parameters were collected. Univariable analyses were conducted to identify predictors of subsidence (≥ 2-mm intrusion of interbody into cranial or caudal vertebrae) and significant subsidence (≥ 4-mm intrusion). Multivariable Cox regression was performed to identify independent predictors of subsidence, expressed as hazard ratios with 95% confidence intervals.
Results: A total of 198 patients treated at 241 levels were included (median age 66.6 years, IQR 59.5, 73.7 years; 56.6% were women). In 92 levels (38.2%) there was some subsidence and in 25 (10.4%) there was significant subsidence. Implanted levels demonstrating subsidence (≥ 2 mm) were associated with lower HU in cranial and caudal vertebrae; had interbodies positioned farther from the anterior apophyseal ring; were implanted with taller, more lordotic interbodies; and underwent greater disc height restoration. Those showing significant subsidence (≥ 4 mm) were similarly associated with lower HU in the cranial and caudal vertebrae; had interbodies positioned farther from the anterior apophyseal ring of the caudal vertebrae; and underwent greater disc height restoration. Multivariable Cox regression showed that time to subsidence was predicted by greater implant height (HR 1.20/mm, 95% CI 1.05-1.38; p = 0.009), greater postoperative disc height (HR 1.21/mm, 95% CI 1.09-1.34; p < 0.001), and greater disc height restoration (HR 1.11/mm, 95% CI 1.04-1.19; p = 0.002). The time-to-subsidence analysis for significant (≥ 4 mm) subsidence showed that it was predicted by lower HU in the cranial vertebrae (HR 0.98/unit, 95% CI 0.97-0.99; p = 0.001); increasing number of levels instrumented (HR 1.26, 95% CI 1.04-1.52; p = 0.016); and greater disc height restoration (HR 1.33/mm, 95% CI 1.18-1.51; p < 0.001).
Conclusions: This time-to-event analysis suggests that interbody subsidence following TLIF is best predicted by implantation of a taller interbody and aggressive disc height restoration. Significant subsidence is similarly predicted by aggressive disc height restoration along with poor baseline bone quality. The results suggest the need to balance aggressive correction at the time of surgery against the increased risk of subsequent interbody subsidence.
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.