21. UNiD技术对成人脊柱畸形多节段TLIF和360度腰椎融合术椎盂参数的比较

IF 2.5 Q3 Medicine

North American Spine Society Journal Pub Date : 2025-07-01 DOI:10.1016/j.xnsj.2025.100715

Taha Khalilullah BS, Ripul R. Panchal DO, FACS

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引用次数: 0

摘要

背景背景ASD患者手术治疗的目标是达到矢状和冠状平衡，减轻轴向疼痛，实现融合。达到脊柱骨盆参数的规范范围，如矢状垂直轴（SVA）、骨盆发生率/腰椎前凸不匹配（PI-LL）和骨盆倾斜（PT）已显示出改善的患者预后。先前通过UNiD人工脊柱智能使用患者特异性棒的研究表明，术后和预测的脊柱骨盆对准与术后2年维持的SVA、PI-LL和腰椎前凸（LL）矫正之间存在统计学上的显著相关性。然而，获得最佳对准的最佳手术入路仍然没有定论。目的比较采用经椎间孔腰椎椎间融合术（TLIF）或后路腰椎椎间融合术（ALIF+PSF）对成人脊柱畸形（ASD）手术患者脊柱骨盆参数的矫正效果，采用人工智能（AI）指导的术前手术计划生成患者特异性UNiD棒。研究设计/设置：单中心回顾性队列研究。患者样本：研究队列包括接受脊柱畸形手术的患者，患者特异性UNiD棒采用TLIF或ALIF + PSF入路。结果测量：术前、计划中和术后通过EOS扫描测量矢状垂直轴（SVA）、骨盆倾斜（PT）、骨盆发生率和腰椎前凸不匹配（PI-LL）。方法14例患者行ASD手术（TLIF = 9,ALIF+PSF = 5）。（术后-计划）（术后-术前）的独立双样本t检验分析所有脊柱参数(p<；0.05)。ALIF组和TLIF组的每个变量与单变量分析相似。术后1年数据分析。结果TLIF组与PT <的对齐效果理想；20°和PI-LL <；在89%和78%的人口中分别有10°。ALIF+PSF组报告与PT <的理想对齐；20°和PI-LL <；80%的人群为10°（p = .891）。从术后-术前角度来看，TLIF组的前凸矫正程度明显高于ALIF组（12.89±11.62 vs 5.2±3.97）（p = .049）。PT、PI- ll、PI差异无统计学意义。尽管ALIF-PSF组的脊柱骨盆差异（术后计划）较小，但也不存在统计学意义。结论：在接受ASD手术的患者中，TLIF组比ALIF组对前凸的矫正在统计学上更大。因此，这可能证明了该入路在矢状面矫正中的优越性。然而，两组均能达到矢状面和脊柱骨盆的标准对齐，但无统计学意义，这说明两种方法都能达到ASD手术的目标。这些发现强调了TLIF和ALIF+PSF手术的影像学结果差异，需要在多中心前瞻性研究中进一步研究，以确定获得最佳脊柱-骨盆对齐的最佳手术。FDA器械/药物状态本摘要不讨论或包括任何适用的器械或药物。

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21. Comparison of spinopelvic parameters of multilevel TLIF and 360 lumbar fusion adult spinal deformity procedures via UNiD technology

BACKGROUND CONTEXT

The goal of surgical treatment for patients with ASD is to achieve sagittal and coronal balance, relieve axial pain, and achieve fusion. Attaining normative ranges of spinopelvic parameters, such as sagittal vertical axis (SVA), pelvic incidence/lumbar lordosis mismatch (PI-LL), and pelvic tilt (PT) has exhibited improved patient outcomes. Prior studies employing patient-specific rods, through UNiD Artificial Spine Intelligence, have demonstrated a statistically significant correlation between postoperative and predicted spinopelvic alignment with correction of SVA, PI-LL, and lumbar lordosis (LL) maintained at 2 years postoperatively. However, the most optimal surgical approach to attain optimal alignment remains inconclusive.

PURPOSE

To compare the correction of spinopelvic parameters of patients who have undergone adult spinal deformity (ASD) surgery with either transforaminal lumbar interbody fusion (TLIF) approach or a posterior approach and anterior lumbar interbody fusion (ALIF+PSF) by employing artificial intelligence (AI) guided preoperative surgical plan to generate patient-specific UNiD rods.

STUDY DESIGN/SETTING

Single-center retrospective cohort study.

PATIENT SAMPLE

The study cohort included patients who underwent spinal deformity surgery with patient specific UNiD rods with either a TLIF or ALIF + PSF approach.

OUTCOME MEASURES

Sagittal spinopelvic parameters sagittal vertical axis (SVA), pelvic tilt (PT), and pelvic incidence and lumbar lordosis mismatch (PI-LL) measured by EOS scans preoperatively, during planning, and postoperatively.

METHODS

Fourteen patients underwent ASD surgery (TLIF = 9, ALIF+PSF = 5). Independent 2-sample t-tests of (Postoperative - Planned) (Postoperative - Preoperative) were analyzed for all spinopelvic parameters (p< 0.05). Each variable was similarly compared with univariate analysis for ALIF and TLIF groups. Postoperative data analyzed at 1 year postoperatively.

RESULTS

The TLIF group reported ideal alignment with PT < 20° and PI-LL < 10° in 89% and 78% of the population respectively. The ALIF+PSF group reported ideal alignment with PT < 20° and PI-LL < 10° in 80% of the population (p = .891). The TLIF group presented with significantly greater lordosis correction compared to the ALIF group from the postoperative-preoperative perspective (12.89 ± 11.62 vs 5.2 ± 3.97) (p = .049). There was no statistical difference in PT, PI-LL and PI. Despite smaller spinopelvic differences (Postoperative-Planned) in the ALIF-PSF group, statistical significance was also not present.

CONCLUSIONS

In patients undergoing ASD surgery with patient-specific UNiD rods, the TLIF group revealed a statistically greater correction of lordosis than the ALIF. As such, this may demonstrate the superiority of this approach in sagittal correction. However, normative sagittal and spinopelvic alignment was achieved without statistical significance in both groups, exemplifying the appropriateness of both procedures to reach the goals of ASD surgery. Such findings highlight the difference in outcomes radiographically for TLIF and ALIF+PSF procedures that need to be researched further in multicenter prospective studies to identify the most optimal procedure for attaining optimal spinopelvic alignment.