Does the Formation of Vertebral Endplate Cysts Predict Nonunion After Lumbar Interbody Fusion?
Does the Formation of Vertebral Endplate Cysts Predict Nonunion After Lumbar Interbody Fusion?
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DOI：
10.1097/brs.0b013e31825d26d7
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发表时间：
2012-09-01
期刊：
影响因子：
3
通讯作者：
Neo, Masashi
中科院分区：
文献类型：
--
作者：
Fujibayashi, Shunsuke;Takemoto, Mitsuru;Neo, Masashi
研究设计。目的探讨腰椎椎体间融合术后终板囊肿形成对骨折愈合状态的影响。目的：评价椎体终板上的囊性变在腰椎融合术后早期发现骨不连中的作用。采用动态X线片、计算机断层扫描(CT)和多平面重建技术，对椎体终板囊肿形成与术后愈合状态之间的关系进行了回顾性研究。虽然许多研究报道了腰椎间融合术后骨性愈合的评估，但还没有关于术后早期骨不连的放射学危险因素的研究报道。椎体终板囊肿形成的意义和重要性尚未见报道，应予以澄清。对76例腰椎椎间融合术后93个节段椎体终板的放射学改变进行了评估。比较骨不连和骨折愈合后3个月椎体终板的CT表现。对椎体终板囊肿形成与骨折愈合状况的关系进行统计学检验。59例骨折愈合病例与17例骨不连病例进行了比较。术后1年愈合率为75.2%，2年愈合率为82.8%。术后1年囊性形成对骨不连的敏感性为69.6%，特异性为100%，阳性预测值为100%，阴性预测值为90.9%。多因素Logistic回归分析显示，多次手术是囊性骨不连的显著预测因素(优势比[OR]：3.8；95%可信区间[CI]：1.1~13.1)，囊性变和多次手术是骨不连的重要预测因素(OR：12.3；95%CI：1.8~133和OR：116；95%CI：22.4-无穷大)。这些发现表明术后早期椎体终板囊肿形成与腰椎间融合术后骨不连有关。终板囊肿的形成是一个有用的早期预测后续骨不连的指标。
Study Design. A retrospective study was conducted to investigate the impact of vertebral endplate cyst formation on union status after lumbar interbody fusion.Objective. To assess the impact of cyst formation at the vertebral endplate in the early detection of nonunion after lumbar interbody fusion. The relationship between vertebral endplate cyst formation and subsequent union status was evaluated retrospectively using dynamic x-ray and computed tomography (CT) and multiplanar reconstruction.Summary of Background Data. Although many studies have reported on the assessment of bony union after lumbar interbody fusion, no study has reported on the radiological risk factors for nonunion in the early postoperative period. The meaning and importance of vertebral endplate cyst formation have not been reported and should be clarified.Methods. Radiological vertebral endplate changes at 93 levels were assessed in 76 patients after transforaminal lumbar interbody fusion, using a titanium cage with pedicle screw fixation. Computed tomographic findings for the vertebral endplate at 3 months were compared between nonunion and union cases. The relationship between vertebral endplate cyst formation and union status was tested statistically.Results. Fifty-nine union cases were compared with 17 nonunion cases. The overall union rate was 75.2% at 1 year and 82.8% at 2 years. At 1 year, the sensitivity of cyst formation for subsequent nonunion was 69.6%, specificity was 100%, positive predictive value was 100%, and negative predictive value was 90.9%. Multivariate logistic regression analysis showed that a multioperated back was a significant predictor of cyst formation (odds ratio [OR]: 3.8; 95% confidence interval [CI]: 1.1-13.1) and that cyst formation and multioperated back were significant predictors of nonunion (OR: 12.3; 95% CI: 1.8-133 and OR: 116; 95% CI: 22.4-infinity, respectively).Conclusion. These findings show a relationship between vertebral endplate cyst formation in the early postoperative period and nonunion after lumbar interbody fusion. Endplate cyst formation is a useful early predictor of subsequent nonunion.