PDF(Pubmed)
Abstract：
OBJECTIVE: Generally, anterior lumbar interbody fusion (ALIF) was believed superior to transforaminal lumbar interbody fusion (TLIF) in induction of fusion. However, many studies have reported comparable results in lumbosacral fusion rate between the two approaches. This study aimed to evaluate the realistic lumbosacral arthrodesis rates following ALIF and TLIF in patients with degenerative spondylolisthesis as measured by CT and radiology.
METHODS: Ninety-six patients who underwent single-level L5-S1 fusion through ALIF (n = 48) or TLIF (n = 48) for degenerative spondylolisthesis at the Spine Center, University of California San Francisco, between October 2014 and December 2017 were retrospectively evaluated. Fusion was independently evaluated and categorized as solid fusion, indeterminate fusion, or pseudarthroses by two radiologists using the modified Brantigan-Steffee-Fraser (mBSF) grade. Clinical data on sex, age, body mass index, Meyerding grade, smoking status, follow-up times, complications, and radiological parameters including disc height, disc angle, segmental lordosis, and overall lumbar lordosis were collected. The fusion results and clinical and radiographic data were statistically compared between the ALIF and TLIF groups by using t-test or chi-square test.
RESULTS: The mean follow-up period was 37.5 (ranging from 24 to 51) months. Clear, solid radiographic fusions were higher in the ALIF group compared with the TLIF group at the last follow-up (75% vs 47.9%, p = 0.006). Indeterminate fusion occurred in 20.8% (10/48) of ALIF cases and in 43.8% (21/48) of TLIF cases (p = 0.028). Radiographic pseudarthrosis was not significantly different between the TLIF and ALIF groups (16.7% vs 8.3%; p = 0.677). In subgroup analysis of the patients without bone morphogenetic protein (BMP), the solid radiographic fusion rate was significantly higher in the ALIF group than that in the TLIF group (78.6% vs 45.5%; p = 0.037). There were no differences in sex, age, body mass index, Meyerding grade, smoking status, or follow-up time between the two groups (p > 0.05). The ALIF group had more improvement in disc height (7.8 mm vs 4.7 mm), disc angle (5.2° vs 1.5°), segmental lordosis (7.0° vs 2.5°), and overall lumbar lordosis (4.7° vs 0.7°) compared with the TLIF group (p < 0.05). Overall complication rates were similar between the TLIF and ALIF groups (10.4% vs 8.33%; p > 0.999).
CONCLUSIONS: With a minimum 2-year radiographic analysis of arthrodesis at lumbosacral level by radiologists, the rate of solid radiographic fusions was higher in the ALIF group compared with the TLIF group, whereas the TLIF group had a higher rate of indeterminate fusion. Radiographic pseudarthrosis did not differ significantly between the TLIF and ALIF groups.
METHODS: Ninety-six patients who underwent single-level L5-S1 fusion through ALIF (n = 48) or TLIF (n = 48) for degenerative spondylolisthesis at the Spine Center, University of California San Francisco, between October 2014 and December 2017 were retrospectively evaluated. Fusion was independently evaluated and categorized as solid fusion, indeterminate fusion, or pseudarthroses by two radiologists using the modified Brantigan-Steffee-Fraser (mBSF) grade. Clinical data on sex, age, body mass index, Meyerding grade, smoking status, follow-up times, complications, and radiological parameters including disc height, disc angle, segmental lordosis, and overall lumbar lordosis were collected. The fusion results and clinical and radiographic data were statistically compared between the ALIF and TLIF groups by using t-test or chi-square test.
RESULTS: The mean follow-up period was 37.5 (ranging from 24 to 51) months. Clear, solid radiographic fusions were higher in the ALIF group compared with the TLIF group at the last follow-up (75% vs 47.9%, p = 0.006). Indeterminate fusion occurred in 20.8% (10/48) of ALIF cases and in 43.8% (21/48) of TLIF cases (p = 0.028). Radiographic pseudarthrosis was not significantly different between the TLIF and ALIF groups (16.7% vs 8.3%; p = 0.677). In subgroup analysis of the patients without bone morphogenetic protein (BMP), the solid radiographic fusion rate was significantly higher in the ALIF group than that in the TLIF group (78.6% vs 45.5%; p = 0.037). There were no differences in sex, age, body mass index, Meyerding grade, smoking status, or follow-up time between the two groups (p > 0.05). The ALIF group had more improvement in disc height (7.8 mm vs 4.7 mm), disc angle (5.2° vs 1.5°), segmental lordosis (7.0° vs 2.5°), and overall lumbar lordosis (4.7° vs 0.7°) compared with the TLIF group (p < 0.05). Overall complication rates were similar between the TLIF and ALIF groups (10.4% vs 8.33%; p > 0.999).
CONCLUSIONS: With a minimum 2-year radiographic analysis of arthrodesis at lumbosacral level by radiologists, the rate of solid radiographic fusions was higher in the ALIF group compared with the TLIF group, whereas the TLIF group had a higher rate of indeterminate fusion. Radiographic pseudarthrosis did not differ significantly between the TLIF and ALIF groups.
摘要：
目标：一般来说，前路腰椎椎间融合术（ALIF）被认为在诱导融合方面优于经椎间孔腰椎椎间融合术（TLIF）。然而,许多研究报道了两种方法在腰骶融合率方面具有可比性的结果。这项研究旨在评估通过CT和放射学测量的退行性腰椎滑脱患者ALIF和TLIF后的实际腰s关节固定术率。
方法：在脊柱中心接受通过ALIF（n=48）或TLIF（n=48）进行单级L5-S1融合的96例患者，加州大学旧金山分校,在2014年10月至2017年12月期间进行回顾性评估.独立评估融合并分类为固体融合，不确定的融合，或两名放射科医生使用改良的Brantigan-Steffee-Fraser（mBSF）等级进行的假关节。关于性别的临床数据，年龄,身体质量指数,梅尔丁等级，吸烟状况,后续时间,并发症,和放射学参数，包括椎间盘高度，圆盘角度,节段前凸,并收集整体腰椎前凸。ALIF组和TLIF组的融合结果与临床及影像学资料进行统计学比较,采用t检验或卡方检验。
结果：平均随访时间为37.5个月（24至51个月）。清除,在最后一次随访时，ALIF组的放射学融合率高于TLIF组（75％vs47.9％，p=0.006)。20.8%(10/48)的ALIF病例和43.8%(21/48)的TLIF病例发生不确定融合(p=0.028)。TLIF和ALIF组之间的影像学假关节没有显着差异（16.7％vs8.3％；p=0.677）。在没有骨形态发生蛋白（BMP）的患者的亚组分析中，ALIF组的固体射线照相融合率明显高于TLIF组（78.6％vs45.5％；p=0.037）。性别没有差异，年龄,身体质量指数,梅尔丁等级，吸烟状况,两组随访时间比较(p>0.05)。ALIF组有更多的改善椎间盘高度（7.8毫米比4.7毫米），圆盘角度(5.2°vs1.5°),节段前凸(7.0°vs2.5°),与TLIF组相比，整体腰椎前凸（4.7°vs0.7°）（p<0.05）。TLIF和ALIF组的总体并发症发生率相似(10.4%vs8.33%;p>0.999)。
结论：放射科医师对腰骶骨水平的关节固定术进行了至少2年的影像学分析，与TLIF组相比，ALIF组的放射学融合率较高，而TLIF组的不确定融合率较高。TLIF和ALIF组之间的影像学假关节没有显着差异。
方法：在脊柱中心接受通过ALIF（n=48）或TLIF（n=48）进行单级L5-S1融合的96例患者，加州大学旧金山分校,在2014年10月至2017年12月期间进行回顾性评估.独立评估融合并分类为固体融合，不确定的融合，或两名放射科医生使用改良的Brantigan-Steffee-Fraser（mBSF）等级进行的假关节。关于性别的临床数据，年龄,身体质量指数,梅尔丁等级，吸烟状况,后续时间,并发症,和放射学参数，包括椎间盘高度，圆盘角度,节段前凸,并收集整体腰椎前凸。ALIF组和TLIF组的融合结果与临床及影像学资料进行统计学比较,采用t检验或卡方检验。
结果：平均随访时间为37.5个月（24至51个月）。清除,在最后一次随访时，ALIF组的放射学融合率高于TLIF组（75％vs47.9％，p=0.006)。20.8%(10/48)的ALIF病例和43.8%(21/48)的TLIF病例发生不确定融合(p=0.028)。TLIF和ALIF组之间的影像学假关节没有显着差异（16.7％vs8.3％；p=0.677）。在没有骨形态发生蛋白（BMP）的患者的亚组分析中，ALIF组的固体射线照相融合率明显高于TLIF组（78.6％vs45.5％；p=0.037）。性别没有差异，年龄,身体质量指数,梅尔丁等级，吸烟状况,两组随访时间比较(p>0.05)。ALIF组有更多的改善椎间盘高度（7.8毫米比4.7毫米），圆盘角度(5.2°vs1.5°),节段前凸(7.0°vs2.5°),与TLIF组相比，整体腰椎前凸（4.7°vs0.7°）（p<0.05）。TLIF和ALIF组的总体并发症发生率相似(10.4%vs8.33%;p>0.999)。
结论：放射科医师对腰骶骨水平的关节固定术进行了至少2年的影像学分析，与TLIF组相比，ALIF组的放射学融合率较高，而TLIF组的不确定融合率较高。TLIF和ALIF组之间的影像学假关节没有显着差异。
