背景:不规则形状的椎体终板与原椎间融合笼的均匀表面之间的不一致已被确定为导致笼沉降,假关节,和不可预测的对齐。制造技术的进步推动了个性化椎间融合器(PIC)的开发,该融合器可以匹配单个端板形态,并提供填充椎间盘空间并实现计划校正所需的确切形状和尺寸。这项研究使用计算机断层扫描(CT)成像来评估植入物-端板接触面积,聚变,沉降,以及在接受PIC装置的患者中实现计划的对准校正。
方法:这项回顾性研究包括在单个部位接受成人脊柱畸形治疗并在L4至L5或L5至S1植入PIC装置以进行节段稳定和对准矫正的患者。作为其护理标准的一部分,他们接受了1年的术后CT图像。使用三维薄切片扫描进行评价。在穿过两个终板的每个CT切片中评估植入物-终板接触和融合迹象。还评估了沉降程度以及节段和整体腰椎对齐的措施。
结果:15名患者被纳入研究,平均年龄68.2岁.随访9~14个月。总共植入了26个腰椎水平;20个通过前路腰椎椎间融合入路使用PIC装置,2通过前路腰椎椎间融合入路,和4通过经椎间孔腰椎椎间融合术采用PIC装置。对PIC植入水平的CT分析发现,植入物与终板的总接触面积比为93.9%,沉降率为4.5%,100%的融合率,与术前计划相比,节段和整体腰椎矫正令人满意。
结论:PIC植入物可以提供与终板表面几乎完全的接触,而与各个终板形态无关。沉降,聚变,在这项层析成像研究中的对齐评估表明,结果与个性化椎间植入物的益处一致。
方法:
BACKGROUND: Incongruity between irregularly shaped vertebral endplates and the uniform surfaces of stock
interbody fusion cages has been identified as contributing to cage subsidence, pseudarthrosis, and unpredictable alignment. Advances in manufacturing techniques have driven the development of personalized
interbody cages (PICs) that can match individual endplate morphology and provide the exact shape and size needed to fill the disc space and achieve the planned correction. This study used computed tomography (CT) imaging to evaluate the implant-endplate contact area, fusion, subsidence, and achievement of planned alignment correction in patients receiving PIC devices.
METHODS: This retrospective study included patients treated for adult spinal deformity at a single site and implanted with PIC devices at L4 to L5 or L5 to S1 for segmental stabilization and alignment correction, who received 1-year postoperative CT images as part of their standard of care. An evaluation using 3-dimensional thin-section scans was conducted. Implant-endplate contact and signs of fusion were assessed in each CT slice across both endplates. The degree of subsidence as well as measures of segmental and global lumbar alignment were also assessed.
RESULTS: Fifteen patients were included in the study, with a mean age of 68.2 years. Follow-up ranged between 9 and 14 months. Twenty-six total lumbar levels were implanted; 20 with PIC devices via the anterior lumbar
interbody fusion approach, 2 with stock cages via the anterior lumbar
interbody fusion approach, and 4 with PIC devices via the transforaminal lumbar
interbody fusion approach. CT analysis of PIC-implanted levels found an overall implant-endplate contact area ratio of 93.9%, a subsidence rate of 4.5%, a fusion rate of 100%, and satisfactory segmental and global lumbar correction compared with the preoperative plan.
CONCLUSIONS: PIC implants can provide nearly complete contact with endplate surfaces regardless of the individual endplate morphology. Subsidence, fusion, and alignment assessments in this tomographic study illustrated results consistent with the benefits of a personalized interbody implant.
METHODS: