背景:术后脊柱前凸分布指数(LDI)异常,量化L4至S1的前凸与L1至S1的前凸之间的比率,有助于进行短节段腰椎椎间融合的患者的相邻节段疾病的发展和翻修率的增加。将术前脊柱骨盆参数和LDI纳入短节段融合的手术计划对于指导对齐恢复和保持未融合节段的正常术前对齐非常重要。这项研究检查了LDI的变化,节段前凸,以及使用个性化椎间融合器(PIC)植入物治疗的患者未融合水平的前凸。
方法:这项回顾性研究评估了111例连续治疗的患者的影像学测量结果,这些患者被诊断患有退行性脊柱疾病,并在融合程序的6个月内使用PIC植入物将L4与L5,L5与S1或L4与S1进行了短节融合。比较了治疗和未治疗水平的椎间前凸以及术前和术后的LDI。
结果:在术前出现高极性分布(LDI<50%)的患者中,术后LDI有统计学意义的增加,接近正常LDI范围(LDI50%-80%)。同样,术前高凸分布(LDI>80%)的患者术后LDI下降,趋向正常范围,尽管变化没有统计学意义.在正常和高度孤立的LDI组中放置PIC后,L5至S1水平的椎间前凸明显增加。术前高凸LDI患者L5至S1的椎间前凸变化不明显。在任何组中均未观察到L1至L4的椎间前凸的相互变化。
结论:PIC植入物可能为患者带来益处,尤其是那些术前出现过高度分布的患者。它们有可能通过帮助外科医生实现患者特定的脊柱前凸目标来进一步改善患者的预后,这可能有助于降低接受短节段腰椎间融合的患者的相邻节段疾病和修正的风险。
结论:个性化植入物可以帮助外科医生实现针对患者的对准目标,可能预防相邻节段疾病,减少长期再干预。
方法:
BACKGROUND: An abnormal postoperative lordosis distribution index (
LDI), which quantifies the ratio between the lordosis at L4 to S1 and the lordosis at L1 to S1, contributes to the development of adjacent segment disease and increased revision rates in patients undergoing short-segment lumbar intervertebral fusions. Incorporating preoperative spinopelvic parameters and
LDI into the surgical plan for short-segment fusion is important for guiding alignment restoration and preserving normal preoperative alignment in unfused segments. This study examined changes in
LDI, segmental lordosis, and lordosis of the unfused levels in patients treated with personalized interbody cage (PIC) implants.
METHODS: This retrospective study evaluated radiographic measurements from 111 consecutively treated patients diagnosed with degenerative spinal conditions and treated with a short-segment fusion of L4 to L5, L5 to S1, or L4 to S1 using PIC implant(s) within 6 months of the fusion procedure. Comparisons of intervertebral lordosis for treated and untreated levels as well as LDI pre- and postoperatively were performed.
RESULTS: In patients with a preoperative hypolordotic distribution (LDI < 50%), statistically significant increases were found in
LDI postoperatively, approaching the normal
LDI range (
LDI 50%-80%). Likewise, patients with hyperlordotic distribution preoperatively (
LDI > 80%) experienced a decrease in LDI postoperatively, trending toward the normal range, although the changes were not statistically significant. Intervertebral lordosis for the L5 to S1 level increased significantly following the placement of a PIC in the normal and hypolordotic LDI groups. Changes in intervertebral lordosis for L5 to S1 were not significant for patients with preoperative hyperlordotic LDI. Reciprocal changes in intervertebral lordosis at L1 to L4 were not observed in any groups.
CONCLUSIONS: PIC implants may provide a benefit for patients, particularly those with hypolordotic distributions preoperatively. They have the potential to further improve patient outcomes by helping surgeons to achieve patient-specific lordosis goals, which may help to reduce the risk of adjacent segment disease and revisions in patients undergoing short-segment lumbar intervertebral fusions.
CONCLUSIONS: Personalized implants can help surgeons achieve patient-specific alignment goals, potentially prevent adjacent segment disease, and reduce long-term reinterventions.
METHODS: