Purpose: Implant subsidence is a possible complication of spinal interbody fusion. We aim to evaluate porous titanium cages subsidence, fusion and functional outcomes in patients subjected to oblique lumbar interbody ...Purpose: Implant subsidence is a possible complication of spinal interbody fusion. We aim to evaluate porous titanium cages subsidence, fusion and functional outcomes in patients subjected to oblique lumbar interbody fusion (OLIF) with these novel devices. Methods: Our institutional review board approved a single-center experience which included 60 patients who underwent OLIF from June 2018 to June 2020 utilizing the porous titanium implants. Data was collected in accordance with the Declaration of Helsinki, and written informed consent was obtained. Imaging studies including radiographs 1, 3, 6 and 12 months and computed tomography (CT) scan at 6 months obtained during routine postoperative follow-up visits, were studied for signs of implant subsidence, fusion and clinical parameters to determine the effectiveness of surgery such as Oswestry disability index (ODI). Results: Radiographic subsidence occurred in 1 out of 89 porous titanium interbody cages (1.1%). No subsidence was observed in the posterior screws and rods fixation group (N = 57). However, one case of subsidence occurred in the lateral plate fixation group (N = 3). The subsidence occurred in an osteoporotic elderly patient operated for adjacent segment disease, and she was later revised with posterior instrumentation using cemented screws and rods. She had an uneventful recovery. Fusion rates were evaluated under CT scan at 6 months with a rate of 88%. In terms of clinical outcomes, ODI decreased significantly from 20.3 preop to 10.7 postop with a P-value Conclusions: In our study, the subsidence rate was lower than previously reported in the literature. Also, we had good fusion rates at 6 months likely due to the porous titanium cages use. We had no subsidence in the posterior instrumented group and one case in the lateral fixation group with improved clinical outcomes.展开更多
目的通过分析颈前路椎间盘切除、椎间融合术(anterior cervical discectomy and fusion,ACDF)术后长期随访患者的影像学资料和神经功能状态,探讨相邻节段病变的形成原因。方法1990年1月-2003年4月,实施ACDF1200余例,52例获得完整随访资...目的通过分析颈前路椎间盘切除、椎间融合术(anterior cervical discectomy and fusion,ACDF)术后长期随访患者的影像学资料和神经功能状态,探讨相邻节段病变的形成原因。方法1990年1月-2003年4月,实施ACDF1200余例,52例获得完整随访资料。男45例,女7例;年龄25～72岁,平均48.5岁。病程3个月～7年9个月,平均23.7个月。椎体融合节段:单间隙10例,双间隙38例,三间隙4例。术前均常规行颈椎正、侧位X线片、CT和MRI检查。采用Nurick评分,对比术后6周及随访结束时的神经功能状态;影像学检查:摄X线片、CT观察融合相邻椎体的滑动和椎体后缘骨赘增生情况,按照Goffin方法转化成半定量退变评分。采用Spearman相关系数法分析Nurick评分、椎体退变程度与患者手术时的年龄、椎体融合节段的关系,椎体退变程度与Nurick评分改变之间的关系。摄MRI观察椎体融合相邻节段及远离节段椎管矢状径的改变。结果52例获随访3～10年,平均6.9年。最后随访时影像学检查示45例(86.5%)患者出现退行性改变,8例(15.4%)自觉神经症状加重,2例(3.8%)接受二次手术治疗。术后6周Nurick评分(1.07±0.84)分,随访结束时(1.92±1.28)分,比较差异有统计学意义(P<0.05);Nurick评分的改变与患者手术时年龄(r=0.21,P>0.05)及椎体融合节段(r=0.30,P>0.05)无相关性。术后6周椎体退变评分(0.73±0.67)分,随访结束时(1.58±1.06)分,比较差异有统计学意义(P<0.01);椎体退变程度与患者手术时年龄(r=0.35,P>0.05)及椎体融合节段(r=0.38,P>0.05)无相关性。MRI显示融合相邻节段上位椎管矢状径减少,比较差异有统计学意义(P<0.01)。融合术后相邻椎体发生明显退行性改变,同时伴有神经症状改变,两者之间统计分析有相关性(r=0.41,P<0.05)。结论ACDF术后相邻节段病变由多种因素引发,椎间盘的自然退变、融合手术造成的生物力学性能的改变、手术对椎体前方韧带结构的破坏及植骨方式均是不可忽视的因素。展开更多
文摘Purpose: Implant subsidence is a possible complication of spinal interbody fusion. We aim to evaluate porous titanium cages subsidence, fusion and functional outcomes in patients subjected to oblique lumbar interbody fusion (OLIF) with these novel devices. Methods: Our institutional review board approved a single-center experience which included 60 patients who underwent OLIF from June 2018 to June 2020 utilizing the porous titanium implants. Data was collected in accordance with the Declaration of Helsinki, and written informed consent was obtained. Imaging studies including radiographs 1, 3, 6 and 12 months and computed tomography (CT) scan at 6 months obtained during routine postoperative follow-up visits, were studied for signs of implant subsidence, fusion and clinical parameters to determine the effectiveness of surgery such as Oswestry disability index (ODI). Results: Radiographic subsidence occurred in 1 out of 89 porous titanium interbody cages (1.1%). No subsidence was observed in the posterior screws and rods fixation group (N = 57). However, one case of subsidence occurred in the lateral plate fixation group (N = 3). The subsidence occurred in an osteoporotic elderly patient operated for adjacent segment disease, and she was later revised with posterior instrumentation using cemented screws and rods. She had an uneventful recovery. Fusion rates were evaluated under CT scan at 6 months with a rate of 88%. In terms of clinical outcomes, ODI decreased significantly from 20.3 preop to 10.7 postop with a P-value Conclusions: In our study, the subsidence rate was lower than previously reported in the literature. Also, we had good fusion rates at 6 months likely due to the porous titanium cages use. We had no subsidence in the posterior instrumented group and one case in the lateral fixation group with improved clinical outcomes.
文摘目的通过分析颈前路椎间盘切除、椎间融合术(anterior cervical discectomy and fusion,ACDF)术后长期随访患者的影像学资料和神经功能状态,探讨相邻节段病变的形成原因。方法1990年1月-2003年4月,实施ACDF1200余例,52例获得完整随访资料。男45例,女7例;年龄25～72岁,平均48.5岁。病程3个月～7年9个月,平均23.7个月。椎体融合节段:单间隙10例,双间隙38例,三间隙4例。术前均常规行颈椎正、侧位X线片、CT和MRI检查。采用Nurick评分,对比术后6周及随访结束时的神经功能状态;影像学检查:摄X线片、CT观察融合相邻椎体的滑动和椎体后缘骨赘增生情况,按照Goffin方法转化成半定量退变评分。采用Spearman相关系数法分析Nurick评分、椎体退变程度与患者手术时的年龄、椎体融合节段的关系,椎体退变程度与Nurick评分改变之间的关系。摄MRI观察椎体融合相邻节段及远离节段椎管矢状径的改变。结果52例获随访3～10年,平均6.9年。最后随访时影像学检查示45例(86.5%)患者出现退行性改变,8例(15.4%)自觉神经症状加重,2例(3.8%)接受二次手术治疗。术后6周Nurick评分(1.07±0.84)分,随访结束时(1.92±1.28)分,比较差异有统计学意义(P<0.05);Nurick评分的改变与患者手术时年龄(r=0.21,P>0.05)及椎体融合节段(r=0.30,P>0.05)无相关性。术后6周椎体退变评分(0.73±0.67)分,随访结束时(1.58±1.06)分,比较差异有统计学意义(P<0.01);椎体退变程度与患者手术时年龄(r=0.35,P>0.05)及椎体融合节段(r=0.38,P>0.05)无相关性。MRI显示融合相邻节段上位椎管矢状径减少,比较差异有统计学意义(P<0.01)。融合术后相邻椎体发生明显退行性改变,同时伴有神经症状改变,两者之间统计分析有相关性(r=0.41,P<0.05)。结论ACDF术后相邻节段病变由多种因素引发,椎间盘的自然退变、融合手术造成的生物力学性能的改变、手术对椎体前方韧带结构的破坏及植骨方式均是不可忽视的因素。
