METHODS: A retrospective study included patients undergoing L4-5 LLIF or TLIF with posterior pedicle screw instrumentation (no posterior osteotomy) for grade 1 spondylolisthesis. Pre-op and 6-month post-op radiographs measured segmental lordosis (L3-L4, L4-L5, L5-S1), lumbar lordosis (LL), and pelvic incidence (PI), along with PI-LL mismatch. Multiple regressions were used for hypothesis testing.
RESULTS: 113 patients (61 LLIF, 52 TLIF) were studied. TLIF showed less change in L4-5 lordosis (mean = 1.04°, SD = 4.34) compared to LLIF (mean = 4.99°, SD = 5.53) (p = 0.003). L4-5 angle changes didn\'t correlate with L3-4 changes, and no disparity between LLIF and TLIF was found (all p > 0.16). In LLIF, greater L4-5 lordosis change predicted reduced compensatory L5-S1 lordosis (p = 0.04), while no significant relationship was observed in TLIF patients (p = 0.12).
CONCLUSIONS: LLIF at L4-5 increases lordosis at the operated level, with compensatory decrease at L5-S1 but not L3-4. This reciprocal loss at adjacent L5-S1 may explain inconsistent improvement in lumbar lordosis (PI-LL) post L4-5 fusion.
方法:一项回顾性研究包括接受L4-5LLIF或TLIF并使用后路椎弓根螺钉(无后路截骨术)治疗1级腰椎滑脱的患者。术前和术后6个月X线片测量节段前凸(L3-L4,L4-L5,L5-S1),腰椎前凸(LL),和骨盆发病率(PI),随着PI-LL不匹配。多元回归用于假设检验。
结果:113例患者(61例LLIF,52TLIF)进行了研究。TLIF显示L4-5脊柱前凸的变化较小(平均值=1.04°,SD=4.34)与LLIF(平均值=4.99°,SD=5.53)(p=0.003)。L4-5角度变化与L3-4变化不相关,LLIF和TLIF之间没有差异(所有p>0.16)。在LLIF中,L4-5脊柱前凸变化较大,可预测代偿性L5-S1脊柱前凸降低(p=0.04),而在TLIF患者中没有观察到显著的相关性(p=0.12)。
结论:L4-5的LLIF在手术水平上增加脊柱前凸,在L5-S1而不是L3-4代偿性降低。相邻L5-S1处的这种相互损失可能解释了L4-5融合后腰椎前凸(PI-LL)的不一致改善。