目的:确定与微创斜腰椎椎间融合术(MIS-OLIF)后每个水平的总变化大于10°的节段角度(SA)校正相关的因素。
方法:对接受单级或二级MIS-OLIF的腰椎管狭窄症患者进行综述。术后即刻X线片中MIS-OLIF后SA>10°校正充分的节段被归类为不连续节段(D节段)。而没有这种改善的人被分配为连续段(C段)。比较了临床和放射学参数,并进行多因素logistic回归分析以确定与MIS-OLIF后SA校正>10°相关的因素。
结果:包括211个部分,38段(18.0%)被分类为D段。与C段相比,D段显示出术前SA明显较小(平均值±标准偏差[SD],-1.1°±6.7°vs.6.6°±6.3°,p<0.001),SA变化较大(平均值±SD,13.5°±3.4°vs.3.1°±3.9°,p<0.001),小关节积液的发生率更高(76.3%vs.48.6%,p=0.002)。Logistic回归显示术前SA(比值比(OR)[95%置信区间(CI)]:0.733[0.639-0.840],p<0.001)和小平面积液(OR[95%CI]:14.054[1.758-112.377],p=0.027)作为MIS-OLIF后>10°SA校正的显著预测因子。
结论:术前脊柱后凸SA和小关节积液可以预测MIS-OLIF后SA校正>10°。对于前凸SA且术前无关节突积液的患者,补充程序,如前柱松解术或后路截骨术,MIS-OLIF治疗后残余整体矢状面失衡所需的额外腰椎前凸矫正准备。
OBJECTIVE: To identify the factors associated with a correction of the segmental angle (SA) with a total change greater than 10° in each level following minimally invasive oblique lumbar interbody fusion (MIS-OLIF).
METHODS: Patients with lumbar spinal stenosis who underwent single- or two-level MIS-OLIF were reviewed. Segments with adequate correction of the SA >10° after MIS-OLIF in immediate postoperative radiograph were categorized as discontinuous segments (D segments), whereas those without such improvement were assigned as continuous segments (C segments). Clinical and radiological parameters were compared, and multivariate logistic regression analysis was performed to identify factors associated with SA correction >10° after MIS-OLIF.
RESULTS: Of 211 segments included, 38 segments (18.0%) were classified as D segments. Compared with C segments, D segments demonstrated a significantly smaller preoperative SA (mean ± standard deviation [SD], - 1.1° ± 6.7° vs. 6.6° ± 6.3°, p < 0.001), larger change of SA (mean ± SD, 13.5° ± 3.4° vs. 3.1° ± 3.9°, p < 0.001), and a higher rate of presence of facet effusion (76.3% vs. 48.6%, p = 0.002). Logistic regression revealed preoperative SA (odds ratio (OR) [95% confidence interval (CI)]:0.733 [0.639-0.840], p < 0.001) and facet effusion (OR [95% CI]:14.054 [1.758-112.377], p = 0.027) as significant predictors for >10° SA correction after MIS-OLIF.
CONCLUSIONS: Preoperative kyphotic SA and facet effusion can predict SA correction >10° following MIS-OLIF. For patients with lordotic SA and no preoperative facet effusion, supplemental procedures, such as anterior column release or posterior osteotomy, should be prepared for additional lumbar lordosis correction required for remnant global sagittal imbalance after MIS-OLIF.