PDF(Pubmed)
Abstract：
UNASSIGNED: It is supposed that additional posterior fusion may provide additional stability of the pedicle screw; however, the clinical impact of additional posterior fusion in patients treated with TLIF remains uncertain. The objective of this study is to assess the clinical efficacy of circumferential fusion in patients treated with TLIF.
UNASSIGNED: This is a single-center retrospective evaluation of consecutive 179 patients with degenerative lumbar stenosis and instability of spinal segments. Patients with axial pain and neurogenic claudication or radiculopathy associated with spinal stenosis were enrolled during the period from 2012 to 2018. Transforaminal lumbar interbody fusion (TLIF) with a single cage was used to treat patients. In 118 cases a supplementary posterior fusion was made. The duration of follow-up accounted for 24 months, logistic regression analysis was used to assess factors that influence the complication rate.
UNASSIGNED: The rate of pedicle screw loosening was growing with radiodensity getting decreased and was more frequent in patients with two level fusion. An increase in pedicle screw loosening rate correlated with anterior nonunion Tan 2 and 3 grade while both posterior complete and incomplete fusion resulted in a decline in the complication rate. Lumbosacral fusion, bilateral facet joints` resection and laminectomy turned out to be insignificant factors. The overall goodness of fit of the estimated general multivariate model was χ2 = 87.2230; P < 0.0001. To confirm clinical relevance of those findings, a univariate logistic regression was performed to assess the association between clinically significant pedicle screw instability and posterior fusion in patients operated on employing TLIF. The results of logistic regression analysis demonstrate that additional posterior fusion may decrease the rate of instrumentation failure that requires revision surgery in patients treated with TLIF [B0 = 1.314321; B1 = -3.218279; p = 0.0023; OR = 24.98507; 95% CI (3.209265; 194.5162), the overall goodness of fit of the estimated regression was χ2 = 22.29538, p = <0.0001].
UNASSIGNED: Circumferential fusion in patients operated on employing TLIF is associated with a decline in the rate of pedicle screw loosening detected by CT imaging and clinically significant instrumentation failure.
UNASSIGNED: This is a single-center retrospective evaluation of consecutive 179 patients with degenerative lumbar stenosis and instability of spinal segments. Patients with axial pain and neurogenic claudication or radiculopathy associated with spinal stenosis were enrolled during the period from 2012 to 2018. Transforaminal lumbar interbody fusion (TLIF) with a single cage was used to treat patients. In 118 cases a supplementary posterior fusion was made. The duration of follow-up accounted for 24 months, logistic regression analysis was used to assess factors that influence the complication rate.
UNASSIGNED: The rate of pedicle screw loosening was growing with radiodensity getting decreased and was more frequent in patients with two level fusion. An increase in pedicle screw loosening rate correlated with anterior nonunion Tan 2 and 3 grade while both posterior complete and incomplete fusion resulted in a decline in the complication rate. Lumbosacral fusion, bilateral facet joints` resection and laminectomy turned out to be insignificant factors. The overall goodness of fit of the estimated general multivariate model was χ2 = 87.2230; P < 0.0001. To confirm clinical relevance of those findings, a univariate logistic regression was performed to assess the association between clinically significant pedicle screw instability and posterior fusion in patients operated on employing TLIF. The results of logistic regression analysis demonstrate that additional posterior fusion may decrease the rate of instrumentation failure that requires revision surgery in patients treated with TLIF [B0 = 1.314321; B1 = -3.218279; p = 0.0023; OR = 24.98507; 95% CI (3.209265; 194.5162), the overall goodness of fit of the estimated regression was χ2 = 22.29538, p = <0.0001].
UNASSIGNED: Circumferential fusion in patients operated on employing TLIF is associated with a decline in the rate of pedicle screw loosening detected by CT imaging and clinically significant instrumentation failure.
摘要：
■据推测，额外的后路融合可以为椎弓根螺钉提供额外的稳定性；但是，在接受TLIF治疗的患者中,额外的后路融合术的临床影响仍不确定.这项研究的目的是评估TLIF治疗患者的圆周融合的临床疗效。
■这是对连续179例退行性腰椎狭窄症和脊柱节段不稳定患者的单中心回顾性评估。在2012年至2018年期间，纳入了轴性疼痛和神经源性跛行或神经根病与椎管狭窄相关的患者。经椎间孔腰椎椎间融合术（TLIF）用于治疗患者。在118例中，进行了补充的后路融合。随访时间占24个月，采用logistic回归分析评估影响并发症发生率的因素。
■椎弓根螺钉松动率随着放射密度的降低而增加，在两级融合患者中更常见。椎弓根螺钉松动率的增加与前部骨不连Tan2和3级相关，而后部完全和不完全融合均导致并发症发生率下降。腰骶融合术,双侧小关节切除术和椎板切除术被证明是无关紧要的因素。估计的一般多变量模型的总体拟合优度为χ2=87.2230;P<0.0001。为了证实这些发现的临床相关性，我们进行了单变量逻辑回归,以评估在采用TLIF手术的患者中有临床意义的椎弓根螺钉不稳定与后路融合之间的关联.逻辑回归分析的结果表明，在接受TLIF治疗的患者中，额外的后路融合可能会降低需要进行翻修手术的器械故障率[B0=1.314321;B1=-3.218279;p=0.0023;OR=24.98507;95％CI（3.209265;194.5162），估计回归的总体拟合优度为χ2=22.29538，p=<0.0001]。
■在使用TLIF的患者中，周向融合与CT成像检测到的椎弓根螺钉松动率下降和临床重大器械失效相关。
■这是对连续179例退行性腰椎狭窄症和脊柱节段不稳定患者的单中心回顾性评估。在2012年至2018年期间，纳入了轴性疼痛和神经源性跛行或神经根病与椎管狭窄相关的患者。经椎间孔腰椎椎间融合术（TLIF）用于治疗患者。在118例中，进行了补充的后路融合。随访时间占24个月，采用logistic回归分析评估影响并发症发生率的因素。
■椎弓根螺钉松动率随着放射密度的降低而增加，在两级融合患者中更常见。椎弓根螺钉松动率的增加与前部骨不连Tan2和3级相关，而后部完全和不完全融合均导致并发症发生率下降。腰骶融合术,双侧小关节切除术和椎板切除术被证明是无关紧要的因素。估计的一般多变量模型的总体拟合优度为χ2=87.2230;P<0.0001。为了证实这些发现的临床相关性，我们进行了单变量逻辑回归,以评估在采用TLIF手术的患者中有临床意义的椎弓根螺钉不稳定与后路融合之间的关联.逻辑回归分析的结果表明，在接受TLIF治疗的患者中，额外的后路融合可能会降低需要进行翻修手术的器械故障率[B0=1.314321;B1=-3.218279;p=0.0023;OR=24.98507;95％CI（3.209265;194.5162），估计回归的总体拟合优度为χ2=22.29538，p=<0.0001]。
■在使用TLIF的患者中，周向融合与CT成像检测到的椎弓根螺钉松动率下降和临床重大器械失效相关。
