Anterior lumbar fusion with paired BAK standard and paired BAK Proximity cages: subsidence incidence, subsidence factors, and clinical outcome.
Anterior lumbar fusion with paired BAK standard and paired BAK Proximity cages: subsidence incidence, subsidence factors, and clinical outcome.
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DOI：
10.1016/s1529-9430(03)00061-5
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发表时间：
2003-07-01
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影响因子：
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通讯作者：
Peppelman, Walter C Jr
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文献类型：
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作者：
Beutler, William J;Peppelman, Walter C Jr
背景：已知前路腰椎椎间融合术（ALIF）有下沉发生率。ALIF手术中特定腰椎节段的个体下沉风险尚未确定。目的：评价两种ALIF结构的下沉发生率。将成对的Bagby和Kuslich（巴克）标准融合器结构与成对的巴克Proximity结构（Sulzer Spine-Tech，Minneapolis，MN）进行比较。研究目的是评价腰椎间盘下沉，包括每个椎间盘节段以及单节段和双节段结构的下沉发生率。研究设计：将使用成对标准BAK融合器融合的70个融合节段的连续系列与使用成对Proximity BAK融合器融合的70个融合节段的后续系列进行比较。患者样本：研究人群来源于由一名外科医生完成的连续系列ALIF手术。1998年，结构从双标准型改为双近端型融合器。2000年，有52名患者接受了2年随访。这些都是匹配到以前的52例患者的双标准construction.OUTCOME MEASURES：临床结果确定使用前和术后奥斯韦斯特里问卷调查。在每年随访时完成术后问卷调查。影像学结果由融合状态和下沉评价确定。还评估了每个融合level.METHODS扩髓深度和椎间融合器尺寸：共52例ALIF手术患者使用配对巴克标准椎间融合器（SS组）与一组52例患者使用配对巴克Proximity椎间融合器（PP组）进行了研究。研究人群来自一项正在进行的前瞻性研究，该研究由一名外科医生完成连续ALIF融合术。椎间盘高度测量用于确定下沉。记录扩髓深度、融合状态和最大下沉部位。临床结果通过术前和术后奥斯韦斯特里功能问卷调查确定。结果：70个SS融合节段中有5个和70个PP融合节段中有9个出现大于2 mm的下沉。在SS下沉的节段中，下沉总是在L4-L5节段。除一个SS结构外，所有结构的双节段融合均发生下沉。9个下沉的PP节段中有8个在L4-L5节段下沉。下沉与扩髓深度增加和使用更大尺寸的椎间融合器相关。下沉多发生在后、上级终板。临床结局不受下沉影响。沉陷发生率与年龄、性别或patient.CONCLUSIONS的体重无关：在ALIF融合术中，使用巴克融合器结构的L4-L5节段的沉陷发生率与其他融合腰椎节段相比有统计学显著性增加。PP结构的下沉发生率增加。下沉还与扩髓深度增加和椎间融合器尺寸增大相关。单节段双标准椎间融合器结构的下沉风险最低。
BACKGROUND CONTEXT: Anterior lumbar interbody fusion (ALIF) procedures have a known incidence of subsidence. The individual risk of subsidence for specific lumbar levels in ALIF procedures has not been determined.PURPOSE: To evaluate the incidence of subsidence with two ALIF constructs. A paired Bagby and Kuslich (BAK) standard cage construct is compared with a paired BAK Proximity construct (Sulzer Spine-Tech, Minneapolis, MN). Study purpose is to evaluate lumbar intervertebral disc subsidence including the subsidence incidence for each disc level and with single- and two-level constructs. Also evaluated is the site of maximal subsidence within each end plate, risk with increased reaming depth, fusion incidence and clinical outcome.STUDY DESIGN: A consecutive series of 70 fused levels fused with paired standard BAK cages is compared with a subsequent series of 70 fused levels using paired Proximity BAK cages.PATIENT SAMPLE: The study population is derived from a consecutive series of ALIF procedures completed by a single surgeon. In 1998 the construct was changed from dual-standard to dual-Proximity cages. In the year 2000 there were 52 patients with a 2-year follow-up. These were matched to the previous 52 patients with dual-standard construct.OUTCOME MEASURES: Clinical outcome was determined using pre- and postoperative Oswestry questionnaires. Postoperative questionnaires were completed at the yearly follow-up. Radiographic outcome was determined by fusion status and evaluation of subsidence. Also evaluated was reaming depth and cage size for each fused level.METHODS: A total of 52 patients with ALIF procedures using paired BAK standard cages (the SS group) were studied with a group of 52 patients using paired BAK Proximity cages (the PP group). The study population was derived from an ongoing prospective study of consecutive ALIF fusion procedures completed by a single surgeon. Disc height measurements were used to determine subsidence. Reaming depth, fusion status and the site of maximal subsidence were all recorded. Clinical outcome was determined with a pre- and postoperative Oswestry functional questionnaire.RESULTS: Subsidence greater than 2 mm was noted in 5 of the 70 SS fused levels and in 9 of the 70 fused PP levels. Subsidence was always at the L4-L5 level in the SS subsided levels. Subsidence was in two-level fusions in all but one of the SS constructs. Subsidence was at the L4-L5 level in eight of the nine subsided PP levels. Subsidence was associated with increased reaming depth and the use of larger cage sizes. Subsidence was usually in the posterior and superior end plate. The clinical outcome was not affected by subsidence. Subsidence incidence was not associated with the age, sex or weight of the patient.CONCLUSIONS: There is a statistically significant increased incidence of subsidence at the L4-L5 level as opposed to other fused lumbar levels in ALIF fusions with BAK cage constructs. There is an increased incidence of subsidence with the PP constructs. Subsidence also is associated with increased reaming depth and with larger cage sizes. The lowest risk for subsidence was with single-level dual-standard cage constructs.