Preliminary results of anterior lumbar interbody fusion, anterior column realignment for the treatment of sagittal malalignment
Preliminary results of anterior lumbar interbody fusion, anterior column realignment for the treatment of sagittal malalignment
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DOI：
10.3171/2017.8.focus17423
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发表时间：
2017-12-01
影响因子：
4.1
通讯作者：
Akbarnia, Behrooz A.
中科院分区：
文献类型：
--
作者：
Hosseini, Pooria;Mundis, Gregory M., Jr.;Akbarnia, Behrooz A.
目的：胸骨对线不良降低了患者的生活质量，可能需要手术矫正以达到重新排列的目的。高风险后路截骨技术是目前解决矢状面对线不良的标准治疗方法。最近，引入了前路腰椎椎间融合、前柱重新对准（ALIF ACR）作为矢状面畸形矫正的替代方法。本文的目的是报告的临床和影像学结果的患者治疗使用ALIF-ACR technology.METHODS的39例ALIF ACR治疗的回顾性研究。研究了患者的人口统计学资料、手术细节、影像学参数、神经功能评估、结局指标以及术前、术后和平均1年随访并发症。（27名女性和12名男性），平均随访时间为13.3 ± 4.7个月，平均年龄为66.1 ± 11.6岁，平均体重指数为27.3 ± 6.2 kg/m2。接受治疗的ALIF节段的平均数量为1.5 +/- 0.5。39例患者中有33例（84.6%）接受了后路脊柱固定，33例（84.6%）接受了后柱截骨术，其中20例（60.6%）在ALIF ACR节段进行。骨盆倾斜、骶骨倾斜和骨盆发生率在术前和术后以及术前和1年随访期之间没有统计学显著差异（除了术前和1年随访之间的PT，p = 0.018）。从术前到术后以及从术前到1年随访，骶椎垂直轴、T-1脊柱骨盆倾斜度、腰椎前凸、骨盆倾角-腰椎前凸不匹配、椎间盘内角度和运动节段角度均有所改善（p < 0.05）。与在ACR水平截骨的ALIF-ACR组相比，未截骨的ALIF-ACR组实现的运动节段角度和椎间盘内角度的变化无统计学显著性。总视觉模拟评分、奥斯韦斯特里残疾指数和脊柱侧凸研究协会-22评分从术前到术后以及从术前到1年随访均有所改善。14例患者（35.9%）发生了26例并发症（15例严重并发症和11例轻微并发症）。11例患者需要再次手术。最常见的并发症是近端交界性脊柱后凸（6/26例并发症，23%），其次是椎体/终板骨折（3/26，12%.CONCLUSIONS本研究显示了令人满意的影像学和临床结果在1年的随访。近端交界性脊柱后凸是最常见的并发症，其次是骨折，这些并发症通常与矢状面重新排列手术相关，并且可能无法通过前路手术缓解。
OBJECTIVE Sagittal malalignment decreases patients' quality of life and may require surgical correction to achieve realignment goals. High-risk posterior-based osteotomy techniques are the current standard treatment for addressing sagittal malalignment. More recently, anterior lumbar interbody fusion, anterior column realignment (ALIF ACR) has been introduced as an alternative for correction of sagittal deformity. The objective of this paper was to report clinical and radiographic results for patients treated using the ALIF-ACR technique.METHODS A retrospective study of 39 patients treated with ALIF ACR was performed. Patient demographics, operative details, radiographic parameters, neurological assessments, outcome measures, and preoperative, postoperative, and mean 1-year follow-up complications were studied.RESULTS The patient population comprised 39 patients (27 females and 12 males) with a mean follow-up of 13.3 +/- 4.7 months, mean age of 66.1 +/- 11.6 years, and mean body mass index of 27.3 +/- 6.2 kg/m(2). The mean number of ALIF levels treated was 1.5 +/- 0.5. Thirty-three (84.6%) of 39 patients underwent posterior spinal fixation and 33 (84.6%) of 39 underwent posterior column osteotomy, of which 20 (60.6%) of 33 procedures were performed at the level of the ALIF ACR. Pelvic tilt, sacral slope, and pelvic incidence were not statistically significantly different between the preoperative and postoperative periods and between the preoperative and 1-year follow-up periods (except for PT between the preoperative and 1-year follow-up, p = 0.018). Sagittal vertical axis, T-1 spinopelvic inclination, lumbar lordosis, pelvic incidence-lumbar lordosis mismatch, intradiscal angle, and motion segment angle all improved from the preoperative to postoperative period and the preoperative to 1-year follow-up (p < 0.05). The changes in motion segment angle and intradiscal angle achieved in the ALIF-ACR group without osteotomy compared with the ALIF-ACR group with osteotomy at the level of ACR were not statistically significant. Total visual analog score, Oswestry Disability Index, and Scoliosis Research Society-22 scores all improved from preoperative to postoperative and preoperative to 1-year follow-up. Fourteen patients (35.9%) experienced 26 complications (15 major and 11 minor). Eleven patients required reoperation. The most common complication was proximal junctional kyphosis (6/26 complications, 23%) followed by vertebral body/endplate fracture (3/26, 12%).CONCLUSIONS This study showed satisfactory radiographic and clinical outcomes at the 1-year follow-up. Proximal junctional kyphosis was the most common complication followed by fracture, complications that are commonly associated with sagittal realignment surgery and may not be mitigated by the anterior approach.