Can cantilever transforaminal lumbar interbody fusion (C-TLIF) maintain segmental lordosis for degenerative spondylolisthesis on a long-term basis?
Can cantilever transforaminal lumbar interbody fusion (C-TLIF) maintain segmental lordosis for degenerative spondylolisthesis on a long-term basis?
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DOI：
10.1007/s00402-014-1925-8
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发表时间：
2014-03-01
影响因子：
2.3
通讯作者：
Tani, Toshikazu
中科院分区：
文献类型：
--
作者：
Kida, Kazunobu;Tadokoro, Nobuaki;Tani, Toshikazu
为了确定使用新月形钛椎间融合器（IBS）的悬臂式经椎间孔腰椎椎间融合术（C-TLIF）是否有利于获得节段性和腰椎前凸，即使是长期退行性脊柱滑脱（DS），我们分析了23例连续患者，这些患者接受了C-TLIF，使用椎弓根螺钉器械加压固定单节段DS。术前、术后2周及末次随访时拍摄侧位X线片，测量椎间盘角度（DA）、节段角度（SA）、腰椎前凸（LL）、椎间盘高度（%DH）和滑脱率（%slip）。节段性脊柱前凸（DA和SA）和%DH最初增加，但随后随着椎间融合器的下沉而减少，仅SA从术前的13.2A度A A +/- A 5.5A度显著增加（p = 0.046）至最终随访时的14.7A度A +/- A 6.4A度。LL和%滑移的变化更一致，没有校正损失，最终显示LL增加了3.6A度（p = 0.005），滑动减少6.7%（p < 0.001）。尽管在存在DS的情况下将IBS放置在上椎骨的前终板上存在固有的局限性，C-TLIF有助于长期显著恢复节段性和腰椎前凸，这将有利于预防脊柱欠凸引起的背痛和相邻节段椎间盘疾病。
To determine if cantilever transforaminal lumbar interbody fusion (C-TLIF) using the crescent-shaped titanium interbody spacer (IBS) favors acquisition of segmental and lumbar lordosis even for degenerative spondylolisthesis (DS) on a long-term basis.We analyzed 23 consecutive patients who underwent C-TLIF with pedicle screw instrumentations fixed with compression for a single-level DS. Measurements on the lateral radiographs taken preoperatively, 2 weeks postoperatively and at final follow-up included disc angle (DA), segmental angle (SA), lumbar lordosis (LL), disc height (%DH) and slip rate (%slip).There was a good functional recovery with 100 % fusion rate at the mean follow-up of 62 months. Segmental lordosis (DA and SA) and %DH initially increased, but subsequently decreased with the subsidence of the interbody spacer, resulting in a significant increase (p = 0.046) only in SA from 13.2A degrees A A +/- A 5.5A degrees preoperatively to 14.7A degrees A A +/- A 6.4A degrees at the final follow-up. Changes of LL and %slip were more consistent without correction loss finally showing an increase of LL by 3.6A degrees (p = 0.005) and a slip reduction by 6.7 % (p < 0.001).Despite the inherent limitation of placing the IBS against the anterior endplate of the upper vertebra in the presence of DS, the C-TLIF helped significantly restore segmental as well as lumbar lordosis on a long-term basis, which would be of benefit in preventing hypolordosis-induced back pain and the adjacent level disc disease.