L5-S1独立前路腰椎椎间融合术(ALIF)是治疗症状性椎间盘退行性疾病的可靠技术,但在治疗峡部滑脱方面仍存在争议。在本研究中,作者旨在确定独立L5-S1ALIF后器械故障和假关节的危险因素,并评估器械故障是否影响融合率。
该研究包括64例患者(男性22例[34.4%],女性42例[65.6%],平均年龄46.4岁[范围21-65岁])使用射线可透的前笼进行独立L5-S1ALIF,并在每个椎体终板上固定Vertebridge钢板。回顾了临床和影像学资料,包括年龄,性别,骨盆参数,节段矢状角(SSA),C7/骶股骨距离(SFD)比,C7矢状倾斜,腰椎前凸(LL),分段LL,L5滑移的百分比,L5-S1盘角,和后椎间盘高度比。使用单变量和多变量分析来识别器械故障和假关节的危险因素。
平均随访15.9个月(范围6.6-27.4个月),57例患者发生融合(89.1%).器械失效12例(18.8%),假关节7例(10.9%)。以下参数影响仪器故障的发生:峡部滑脱的存在(p<0.001),脊椎滑脱等级(p<0.001),使用髂骨自体移植(p=0.04),保持架高度(p=0.03),骨盆发病率(PI)(p<0.001),骶骨斜率(SS)(p<0.001),SSA(p=0.003),和LL(p<0.001)。仪器故障与L5-S1假关节的发生有统计学联系(p<0.001)。在多变量分析中,未发现危险因素.
在L5-S1独立ALIF的情况下,L5-S1峡部滑脱和高PI似乎是仪器故障的危险因素,研究结果支持在这些情况下增加经皮后路椎弓根螺钉的必要性。
L5-S1 stand-alone anterior lumbar interbody fusion (ALIF) is a reliable technique to treat symptomatic degenerative disc disease but remains controversial for treatment of isthmic spondylolisthesis. In the present study the authors aimed to identify risk factors of instrumentation failure and pseudarthrosis after stand-alone L5-S1 ALIF and to evaluate whether instrumentation failure influenced the rate of fusion.
The study included 64 patients (22 [34.4%] male and 42 [65.6%] female, mean age 46.4 years [range 21-65 years]) undergoing stand-alone L5-S1 ALIF using radiolucent anterior cages with Vertebridge plating fixation in each vertebral endplate. Clinical and radiographic data were reviewed, including age, sex, pelvic parameters, segmental sagittal angle (SSA), C7/sacro-femoral distance (SFD) ratio, C7 sagittal tilt, lumbar lordosis (LL), segmental LL, percentage of L5 slippage, L5-S1 disc angle, and posterior disc height ratio. Univariate and multivariate analyses were used to identify risk factors of instrumentation failure and pseudarthrosis.
At a mean follow-up of 15.9 months (range 6.6-27.4 months), fusion had occurred in 57 patients (89.1%). Instrumentation failure was found in 12 patients (18.8%) and pseudarthrosis in 7 patients (10.9%). The following parameters influenced the occurrence of instrumentation failure: presence of isthmic spondylolisthesis (p < 0.001), spondylolisthesis grade (p < 0.001), use of an iliac crest bone autograft (p = 0.04), cage height (p = 0.03), pelvic incidence (PI) (p < 0.001), sacral slope (SS) (p < 0.001), SSA (p = 0.003), and LL (p < 0.001). Instrumentation failure was statistically linked to the occurrence of L5-S1 pseudarthrosis (p < 0.001). On multivariate analysis, no risk factors were found.
L5-S1 isthmic spondylolisthesis and high PI seem to be risk factors for instrumentation failure in case of stand-alone L5-S1 ALIF, findings that support the necessity of adding percutaneous posterior pedicle screw instrumentation in these cases.