P4。腰椎后路椎间融合术后椎笼后移的预防

IF 2.5 Q3 Medicine

North American Spine Society Journal Pub Date : 2025-07-01 DOI:10.1016/j.xnsj.2025.100628

Hiroyuki Aono MD

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引用次数: 0

摘要

背景背景后路腰椎椎体间融合术（PLIF）后的椎笼后退是一种罕见但严重的并发症，在许多病例中需要进行翻修手术。为了探讨这一并发症和潜在的预防措施，我们回顾性分析了我院采用一致的手术技术进行的一系列PLIF手术。研究设计/设置：这是一项回顾性研究。患者样本：我们回顾了我院2006年6月至2024年5月间因腰椎退行性疾病进行PLIF手术的手术数据库。接受PLIF并术后随访至少6个月的患者纳入本研究。结果：通过最新随访的侧位x线片，将cage向后移动定义为cage向椎管内的后侧移动。方法所有PLIF手术采用标准化技术，包括双侧面切除术、椎间盘次全切除术、彻底的局部植骨（至少两个支撑骨块和两个盒型笼）和椎弓根螺钉内固定。还分析了患者人口统计学（年龄、性别）和融合节段的数量。结果共纳入918例患者，随访率97%。该队列包括316名男性和602名女性，平均年龄为71岁。共融合1133个等级（一级：887，二级：119，三级：6）。92例PLIF手术治疗邻近节段疾病。未观察到笼形排斥现象。结论PLIF/ tliff术后笼后推的发生率为0.8% ~ 4.7%。危险因素包括年龄较大、体重指数高、多层次融合、笼的大小和形状、终板损伤和椎间盘间隙形态。我们认为，我们一贯的手术技术，特别是强调彻底的椎间盘切除术和植骨，可能是我们的研究中没有出现椎笼反推的原因。FDA器械/药物状态椎间盘保持器（批准用于此适应症）。

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P4. Prevention for cage retropulsion following posterior lumbar interbody fusion

BACKGROUND CONTEXT

Cage retropulsion following posterior lumbar interbody fusion (PLIF) is a rare but serious complication requiring revision surgery in many cases.

PURPOSE

To investigate this complication and potential preventive measures, we retrospectively analyzed a series of PLIF procedures performed at our institution using a consistent surgical technique.

STUDY DESIGN/SETTING

This is a retrospective study.

PATIENT SAMPLE

We reviewed the surgical database of our institution for PLIF procedures performed between June 2006 and May 2024 for degenerative lumbar disease. Patients who underwent PLIF and were followed up for at least six months postoperatively were included in this study.

OUTCOME MEASURES

Cage retropulsion was defined as posterior migration of the cage into the spinal canal, by lateral radiographs at latest follow up.

METHODS

All PLIF procedures were performed using a standardized technique involving bilateral facetectomy, subtotal discectomy, thorough local bone grafting (at least two strut bone blocks with two box-type cages), and pedicle screw instrumentation. Patient demographics (age, sex) and the number of fused levels were also analyzed.

RESULTS

A total of 918 patients were included in this study (97% follow-up rate). The cohort consisted of 316 males and 602 females with a mean age of 71 years. A total of 1,133 levels were fused (one-level: 887, two-level: 119, three-level: 6). Ninety-two PLIF procedures were performed to treat adjacent segment disease. No cases of cage retropulsion were observed.

CONCLUSIONS

The reported incidence of cage retropulsion after PLIF/TLIF ranges from 0.8% to 4.7%. Risk factors include older age, high body mass index, multi-level fusion, cage size and shape, endplate injury, and disc space morphology. We believe that our consistent surgical technique, particularly emphasizing thorough discectomy and bone grafting, may have contributed to the absence of cage retropulsion in our series.