Effect of intraoperative position in single-level transforaminal lumbar interbody fusion at the L4/5 level on segmental and overall lumbar lordosis in patients with lumbar degenerative disease
Effect of intraoperative position in single-level transforaminal lumbar interbody fusion at the L4/5 level on segmental and overall lumbar lordosis in patients with lumbar degenerative disease
复制标题
DOI：
10.1097/md.0000000000017316
复制
发表时间：
2019-09-01
期刊：
影响因子：
1.6
通讯作者：
Tsumura, Hiroshi
中科院分区：
文献类型：
--
作者：
Miyazaki, Masashi;Ishihara, Toshinobu;Tsumura, Hiroshi
本研究的目的是研究单节段（L4-5）经椎间孔腰椎椎间融合术（TLIF）术中体位对腰椎退行性疾病患者节段和整体腰椎前凸（LL）的影响。对38名连续患者进行了使用0度聚醚醚酮（PEEK）融合器和椎弓根螺钉固定进行单节段（L4-5）TLIF的评价。20例患者在髋关节屈曲30度的四柱型框架上接受手术（I组），18例患者在杰克逊脊柱台上接受手术，将髋关节屈曲调整至0度（II组）。对每例患者拍摄术前站立位、术中俯卧位和术后站立位侧位X线片。根据患者手术时的体位分析整体和节段LL，并比较I组和II组的结果。与I组相比，II组术中L4-5和L5-S1的椎间节段LL增加，而术后L4-5（融合节段）的椎间节段LL增加。在组I中，L4-5的术中椎间节段LL未实现充分的脊柱前凸，而L3-4的术后椎间节段LL增加。由于上部相邻节段的补偿，融合节段中节段LL的降低不影响整体脊柱对线。术中髋关节延长越多，下腰椎节段性前凸增加越多。因此，选择合适的手术床和髋关节位置非常重要。节段性脊柱前凸的不充分导致上相邻节段负荷的加速。
The purpose of this study was to investigate the effect of intraoperative positions in single-level (L4-5) transforaminal lumbar interbody fusion (TLIF) on segmental and overall lumbar lordosis (LL) in patients with lumbar degenerative disease. Thirty-eight consecutive patients who had undergone single-segment (L4-5) TLIF with 0 degrees polyetheretherketone (PEEK) cage and pedicle screw fixation were evaluated. Twenty patients underwent surgery on the four-poster type frame with hip flexion at 30 degrees (Group I) and 18 patients were operated on a Jackson spinal table to adjust their hip flexion to 0 degrees (Group II). Preoperative standing, intraoperative prone, and postoperative standing lateral radiographs were obtained in each patient. The overall and segmental LL were analyzed according to the position in which the patients were placed for their operation and results compared between Groups I and II. Intraoperative intervertebral segmental LL at L4-5 and L5-S1 was increased in Group II than in Group I, whereas postoperative intervertebral segmental LL at L4-5 (fused level) was increased LL. In Group I intraoperative intervertebral segmental LL at L4-5 did not achieve sufficient lordosis, whereas postoperative intervertebral segmental LL at L3-4 was increased. The overall spinal alignment was unaffected by the decreased segmental LL in the fused level owing to the compensation of the upper adjacent segments. The more the hip was extended intraoperatively, the more the segmental lordosis increased in the lower lumbar spine. Thus, selecting the appropriate surgical table and hip position are very important. Underachievement of segmental lordosis leads to the acceleration of upper adjacent segment load.