Predictability in Achieving Target Intervertebral Lordosis Using Personalized Interbody Implants.

IF 1.7 Q2 SURGERY International Journal of Spine Surgery Pub Date : 2024-08-30 DOI:10.14444/8637

Saeed S Sadrameli, Donald J Blaskiewicz, Jahangir Asghar, Christopher P Ames, Gregory M Mundis, Joseph A Osorio, Justin S Smith, Chun-Po Yen, Sigurd H Berven, Ashvin I Patel, Michele Temple-Wong, Rodrigo J Nicolau, Roland S Kent

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Abstract

Background: Lumbar lordosis distribution has become a pivotal factor in re-establishing the foundational alignment of the lumbar spine. This can directly influence overall sagittal alignment, leading to improved long-term outcomes for patients. Despite the wide availability of hyperlordotic stock cages intended to achieve optimal postoperative alignment, there is a lack of correlation between the lordotic shape of a cage and the resultant intervertebral alignment. Recently, personalized spine surgery has witnessed significant advancements, including 3D-printed personalized interbody implants, which are customized to the surgeon's treatment and alignment goals. This study evaluates the reliability of 3D-printed patient-specific interbody implants to achieve the planned postoperative intervertebral alignment.

Methods: This is a retrospective study of 217 patients with spinal deformity or degenerative conditions. Patients were included if they received 3D-printed personalized interbody implants. The desired intervertebral lordosis (IVL) angle was prescribed into the device design for each personalized interbody (IVL goal). Standing postoperative radiographs were measured, and the IVL offset was calculated as IVL achieved minus IVL goal.

Results: In this patient population, 365 personalized interbodies were implanted, including 145 anterior lumbar interbody fusions (ALIFs), 99 lateral lumbar interbody fusions (LLIFs), and 121 transforaminal lumbar interbody fusions. Among the 365 treated levels, IVL offset was 1.1° ± 4.4° (mean ± SD). IVL was achieved within 5° of the plan in 299 levels (81.9%). IVL offset depended on the approach of the lumbar interbody fusion and was achieved within 5° for 85.9% of LLIF, 82.6% of transforaminal lumbar interbody fusions and 78.6% of ALIFs. Ten levels (2.7%) missed the planned IVL by >10°. ALIF and LLIF levels in which the plan was missed by more than 5° tended to be overcorrected.

Conclusions: This study supports the use of 3D-printed personalized interbody implants to achieve planned sagittal intervertebral alignment.

Clinical relevance: Personalized interbody implants can consistently achieve IVL goals and potentially impact foundational lumbar alignment.

Level of evidence: 4:

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使用个性化椎间植入物实现目标椎体后凸的可预测性

背景：腰椎前凸分布已成为重建腰椎基础对齐的关键因素。这可直接影响整体矢状排列，从而改善患者的长期治疗效果。尽管目前市场上有很多旨在实现最佳术后对位的超脊柱侧弯固定架，但固定架的侧弯形状与由此产生的椎间对位之间缺乏相关性。最近，个性化脊柱手术取得了重大进展，包括根据外科医生的治疗和对位目标定制的 3D 打印个性化椎间植入物。本研究评估了三维打印患者特异性椎间植入物实现术后椎间对位计划的可靠性：这是一项回顾性研究，研究对象为 217 名脊柱畸形或退行性病变患者。接受过 3D 打印个性化椎间植入物的患者均被纳入研究范围。每个个性化椎间植入物（IVL 目标）的装置设计中都规定了所需的椎间前凸（IVL）角度。测量术后立位X光片，计算IVL偏移量，即达到的IVL减去IVL目标：结果：在这一患者群体中，共植入了 365 个个性化椎间融合器，包括 145 个前路腰椎椎体间融合器（ALIF）、99 个侧路腰椎椎体间融合器（LLIF）和 121 个经椎间孔腰椎椎体间融合器。在接受治疗的 365 个水平中，IVL 偏移为 1.1° ± 4.4°（平均值 ± SD）。有 299 个椎板水平（81.9%）的 IVL 与计划值相差 5°。IVL偏移量取决于腰椎椎间融合术的方法，85.9%的LLIF、82.6%的经椎间孔腰椎椎间融合术和78.6%的ALIF的IVL偏移量在5°以内。有 10 个水平（2.7%）与计划的 IVL 相差大于 10°。计划偏差超过5°的ALIF和LLIF水平往往矫正过度：这项研究支持使用 3D 打印的个性化椎间植入物来实现计划的矢状椎体间对齐：临床相关性：个性化椎间植入物可持续实现IVL目标，并可能影响腰椎的基础对线：4:

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来源期刊

International Journal of Spine Surgery Medicine-Surgery

CiteScore

3.10

自引率

0.00%

发文量

162

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.