斜行腰椎椎间融合术中的骨架偏斜--有多常见,对融合率、下沉和矢状对齐有何影响?基于计算机断层扫描的分析。

IF 1.7 Q2 SURGERY International Journal of Spine Surgery Pub Date : 2024-08-08 DOI:10.14444/8623
Bryan Chun Meng Foong, Joey Ying Hao Wong, Brjan Betzler, Jacob Yoong Leong Oh
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引用次数: 0

摘要

背景:通过prepsoas方法进行斜腰椎椎体间融合术(OLIF)被认为是减轻直接侧位椎体间融合术并发症的一种替代方法。众所周知,笼架的放置会影响笼架下沉和融合率,这是由于生物力学不理想造成的。将椎笼斜度作为影响融合结果的潜在因素进行探讨的研究非常有限。因此,我们的目标是评估在接受 OLIF 的患者中,保持架斜度和位置对融合率、下陷和矢状对位的影响:研究对象包括在本中心接受 L1 至 L5 水平 OLIF 的患者,由一名外科医生实施,随访至少 12 个月。对椎笼斜度和矢状位进行测量,并评估其与融合、下陷和矢状对齐矫正的相关性。融合和下沉分别采用布里德维尔标准和马奇标准进行评估:在纳入的患者中(年龄为 67.5 ± 7.93 岁;16 名男性和 37 名女性),共研究了 97 个融合水平。平均骨笼斜度为 4.2° ± 2.8°。96个融合水平(99.0%)的布里德维尔评分为1或2分。81个(83.5%)、14个(14.4%)和2个(2.06%)手术水平的马奇评分分别为0、1和2。马奇评分为 1 分或更高时,表明有明显的下陷。节段前凸角(4.2° ± 5.7°;P < 0.0001)和椎间盘高度(4.5 ± 3.8 mm;P < 0.0001)均有良好改善。Cage放置与融合率、下沉或矢状对齐没有任何统计学相关性:结论:我们的研究结果表明,OLIF有利于适当地放置骨笼,但骨笼的倾斜度较小,通常小于20°。这种轻微的倾斜不会导致融合率降低、下陷增加或矢状对齐不良。尽管下沉很常见,但这些病例中的大多数都能完全融合:3:
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Cage Obliquity in Oblique Lumbar Interbody Fusion-How Common Is It and What Are the Effects on Fusion Rates, Subsidence, and Sagittal Alignment? A Computed Tomography-Based Analysis.

Background: Oblique lumbar interbody fusion (OLIF) through a prepsoas approach was identified as an alternative to alleviate complications associated with direct lateral interbody fusion. Cage placement is known to influence cage subsidence and fusion rates due to suboptimal biomechanics. There are limited studies exploring cage obliquity as a potential factor influencing fusion outcomes. Hence, our objective was to assess the effects of cage obliquity and position on fusion rates, subsidence, and sagittal alignment in patients who underwent OLIF.

Methods: Patients who underwent OLIF for levels L1 to L5 in our center, performed by a single surgeon and with a minimum of 12 months of follow-up, were included in the study. Cage obliquity and sagittal placement were measured, and their correlation with fusion, subsidence, and sagittal alignment correction was assessed. Fusion and subsidence were evaluated using the Bridwell Criteria and Marchi Criteria, respectively.

Results: Among the included patients (age, 67.5 ± 7.93 years; 16 men and 37 women), 97 fusion levels were studied. The mean cage obliquity was 4.2° ± 2.8°. Ninety-six levels (99.0%) were considered to have achieved fusion with a Bridwell score of 1 or 2. Eighty-one (83.5%), 14 (14.4%), and 2 (2.06%) operated levels had a Marchi score of 0, 1, and 2, respectively. A Marchi grade of 1 or higher was considered indicative of significant subsidence. There was good improvement in both the segmental lordosis angle (4.2° ± 5.7°; P < 0.0001) and disc height (4.5 ± 3.8 mm; P < 0.0001). Cage placement did not have any statistical correlation with fusion rates, subsidence, or sagittal alignment.

Conclusions: Our results indicate that OLIF facilitates appropriate cage placement with only a minor degree of cage obliquity, typically less than 20°. This minor obliquity does not lead to lower fusion rates, increased subsidence, or sagittal malalignment. Despite subsidence being common, the majority of these cases resulted in complete fusion.

Level of evidence: 3:

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来源期刊
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.
期刊最新文献
Beyond the Limits to Become a Leading Force in Global Spine Surgery: Present and Future of Spine Surgery in Asia-Pacific. Comparing ACDF Outcomes by Cervical Spine Level: A Single Center Retrospective Cohort Study. Editorial: Embracing Rasch Analysis for Enhanced Spine Surgery Outcomes-The Outsider's Viewpoint. Editors' Introduction: High-Value Endoscopic Techniques: Integrating Surgeon Skill and Experience in Spine Surgery With Rasch Analysis. Invited Commentary: Rasch Analysis and High-Value Spinal Endoscopy.
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