背景:在退行性腰椎滑脱症(DLS)的手术中经常进行椎体滑脱复位。这种方法,虽然有可能改善临床和放射学结果,由于还原过程,还存在增加并发症的风险。为了解决这个问题,我们引入了一种用于DLS治疗的创新杠杆降低技术。本研究旨在探讨临床疗效,放射学结果,以及有或没有杠杆复位的融合并发症。
方法:我们对接受DLS腰椎融合手术的患者的前瞻性数据进行了回顾性研究,随访至少24个月。自我报告的措施包括背部或腿部疼痛的视觉模拟量表(VAS),Oswestry残疾指数(ODI),并实现最小的临床重要差异(MCID)。放射学评估包括脊椎滑脱百分比(SP),局灶性脊柱前凸(FL),和腰椎前凸(LL)。使用改良的Clavien-Dindo分类(MCDC)方案对并发症进行分类。根据杠杆复位技术的应用,将患者分为复位组(RG)和非复位组(NRG)。基线时的临床和放射学结果,手术后立即,并在最后一次随访时进行了比较。
结果:共分析了281例患者(123NRG,158RG)。基线患者人口统计,合并症,除手术时间外,手术特征在组间分布相似(NRG129.25分钟,RG138.04分钟,P=.009)。两组患者术后均表现出显著的临床改善(均,P=.000),组间没有实质性差异(VAS,ODI,或达到MCID的能力)。RG患者在随访期间显示出统计学上较低的SP和较高的FL(所有,P=.000)。LL在各组内的不同时间点或两组之间的相同时间点具有可比性(所有,P>.050)。总并发症发生率(NRG38.2%,RG27.2%,P=0.050)或每个MCDC的特定并发症发生率在组间相似(所有,P>.050)。RG患者的相邻节段变性(ASDeg)风险较低(NRG9.8%,RG6.3%,P=.035)。
结论:术后测量结果如腰腿痛的VAS评分无显著差异,ODI,到达MCID的能力,总并发症发生率,或手术入路之间每个MCDC的特定并发症发生率。然而,与原位融合相比,杠杆复位融合在恢复节段脊柱矢状面对齐和减少ASDeg的发生方面具有显着优势。
BACKGROUND: The reduction of slipped vertebra is often performed during surgery for degenerative lumbar spondylolisthesis (DLS). This approach, while potentially improving clinical and radiological outcomes, also carries a risk of increased complications due to the reduction process. To address this, we introduced an innovative lever reduction technique for DLS treatment. This study aims to investigate the clinical efficacy, radiological outcomes, and complications of fusion with or without lever reduction.
METHODS: We conducted a retrospective review of prospectively collected data from a registry of patients who underwent lumbar fusion surgery for DLS, with a follow-up of at least 24 months. Self-reported measures included visual analog scale (VAS) for back or leg pain, Oswestry Disability Index (ODI), and the achievement of minimal clinically important difference (MCID). Radiological assessments encompassed spondylolisthesis percentage (SP), focal lordosis (FL), and lumbar lordosis (LL). Complications were categorized using the modified Clavien-Dindo classification (MCDC) scheme. Patients were assigned to the reduction group (RG) and non-reduction group (NRG) based on the application of the lever reduction technique. Clinical and radiological outcomes at baseline, immediately after surgery, and at the last follow-up were compared.
RESULTS: A total of 281 patients were analyzed (123 NRG, 158 RG). Baseline patient demographics, comorbidities, and surgical characteristics were similarly distributed between groups except for operating time (NRG 129.25 min, RG 138.04 min, P = .009). Both groups exhibited significant clinical improvement after surgery (all, P = .000), with no substantial difference between groups (VAS, ODI, or the ability to reach MCID). Patients in RG showed statistically lower SP and higher FL during follow-up (all, P = .000). LL was comparable at different time points within each group or at the same time point between the two groups (all, P > .050). The overall complication rate (NRG 38.2%, RG 27.2%, P = .050) or specific complication rates per MCDC were similar between groups (all, P > .050). Patients in RG were predisposed to a lower risk of adjacent segment degeneration (ASDeg) (NRG 9.8%, RG 6.3%, P = .035).
CONCLUSIONS: There were no significant differences in postoperative measures such as VAS scores for back and leg pain, ODI, the ability to reach MCID, overall complication rate, or specific complication rates per MCDC between surgical approaches. However, fusion with lever reduction demonstrated a notable advantage in restoring segmental spinal sagittal alignment and reducing the occurrence of ASDeg compared to in situ fusion.