与侧后路胸腰椎融合术后硬件失败相关的因素-十年病例系列。
Factors associated with hardware failure after lateral thoracolumbar fusions - A ten year case series.
机构信息
Department of Neurosurgery & Brain Repair, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
Department of Neurosurgery & Brain Repair, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
出版信息
Clin Neurol Neurosurg. 2023 Jan;224:107564. doi: 10.1016/j.clineuro.2022.107564. Epub 2022 Dec 21.
OBJECTIVE
Thoracolumbar lateral interbody fusions (tLLIF) are one tool in the spine surgeon's toolbox to indirectly decompress neuroforamina while also improving segmental lordosis in a biomechanically distinct manner from posterior fusions. When part of a concomitant posterior construct, hardware failure (HF), sometimes requiring revision surgery, can occur. We sought to study the relationship between tLLIF and HF.
METHODS
We conducted a retrospective study on consecutive patents who underwent tLLIF at a single academic center between January 2012 and December 2021 by seven unique neurosurgeons. Patients were excluded if they had no posterior instrumentation within their construct or if they had less than six months of follow-up. Hardware failure was defined as screw breakage or rod fracture seen on postoperative imaging.
RESULTS
232 patients were identified; 6 (2.6 %) developed HF throughout a mean follow-up of 1182 days (range =748-1647 days). Adjacent segment disease was the most common pathology addressed (75 patients (32.3 %)). The amount of posterior instrumentation both in the surgery in question and in the total construct were significantly higher in the HF cohort (4.33 ± 1.52 levels, 5.83 ± 3.36 levels) versus the non-HF cohort (2.08 ± 0.296 levels, p = 0.014; 2.86 ± 0.316 levels, p = 0.003, respectively). The number of interbody devices added in the index surgery and in the entire construct were both significantly higher in the HF cohort (3.33 ± 0.666 interbody devices, 3.33 ± 0.666 devices) than in the non-HF cohort (1.88 ± 0.152 interbody devices, p = 0.002; 2.31 ± 0.158 devices, p = 0.036, respectively). Higher amounts of lateral levels of fusion approached significance for association with HF (HF: 2.67 ± 0.844 levels, no HF: 1.73 ± 1.26 levels, p = 0.076). On multivariate analysis, only the number of interbody devices added in the index surgery was predictive of HF (Odds ratio=2.3, 95 % confidence interval=1.25-4.23, p = 0.007).
CONCLUSION
Greater levels of posterior fusion, and greater numbers of interbody devices in an index surgery and in a construct as a whole, were associated with higher rates of HF in our cohort of patients with tLLIF. Greater numbers of lateral segments fused in this population may also be related to HF.
目的
胸腰椎侧前路融合术（tLLIF）是脊柱外科医生间接减压神经孔的工具之一，同时也以不同于后路融合术的生物力学方式改善节段前凸。当它是后路融合术的一部分时，有时会发生内固定物失效（HF），需要进行翻修手术。我们旨在研究 tLLIF 与 HF 的关系。
方法
我们对 2012 年 1 月至 2021 年 12 月期间在一家学术中心接受 tLLIF 的连续患者进行了回顾性研究，由七位不同的神经外科医生进行。如果患者的融合结构中没有后路器械或随访时间少于 6 个月，则将其排除在外。内固定物失效定义为术后影像学上可见螺钉断裂或杆断裂。
结果
共确定了 232 名患者；6 名（2.6%）在平均 1182 天（范围=748-1647 天）的随访中发生 HF。最常见的病理学问题是相邻节段疾病（75 名患者（32.3%））。HF 组中手术和整个融合结构中后部器械的数量明显更高（4.33±1.52 个水平，5.83±3.36 个水平），而非 HF 组（2.08±0.296 个水平，p=0.014；2.86±0.316 个水平，p=0.003）。在索引手术和整个结构中添加的椎间设备数量在 HF 组中均明显更高（3.33±0.666 个椎间设备，3.33±0.666 个设备），而非 HF 组（1.88±0.152 个椎间设备，p=0.002；2.31±0.158 个设备，p=0.036）。更高数量的侧位融合水平接近与 HF 相关的显著性（HF：2.67±0.844 个水平，非 HF：1.73±1.26 个水平，p=0.076）。多变量分析表明，只有在索引手术中添加的椎间设备数量与 HF 相关（优势比=2.3，95%置信区间=1.25-4.23，p=0.007）。
结论
在接受 tLLIF 的患者队列中，后路融合的水平更高，索引手术和整个结构中添加的椎间设备数量更多，与 HF 的发生率更高相关。在该人群中，更多的侧节段融合也可能与 HF 相关。
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