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1.
Suzanne L. de Kunder Sander M.J. van Kuijk Kim Rijkers Inge J.M.H. Caelers Wouter L.W. van Hemert Rob A. de Bie Henk van Santbrink 《The spine journal》2017,17(11):1712-1721
Background Context
Transforaminal lumbar interbody fusion (TLIF) and posterior lumbar interbody fusion (PLIF) are both frequently used as a surgical treatment for lumbar spondylolisthesis. Because of the unilateral transforaminal route to the intervertebral space used in TLIF, as opposed to the bilateral route used in PLIF, TLIF could be associated with fewer complications, shorter duration of surgery, and less blood loss, whereas the effectiveness of both techniques on back or leg pain is equal.Purpose
The objective of this study was to compare the effectiveness of both TLIF and PLIF in reducing disability, and to compare the intra- and postoperative complications of both techniques in patients with lumbar spondylolisthesis.Study Design/Setting
A systematic literature review and meta-analysis were carried out.Methods
We conducted a Medline (using PubMed), Embase (using Ovid), Cochrane Library, Current Controlled Trials, ClinicalTrials.gov and NHS Centre for Review and Dissemination search for studies reporting TLIF, PLIF, lumbar spondylolisthesis and disability, pain, complications, duration of surgery, and estimated blood loss. A meta-analysis was performed to compute pooled estimates of the differences between TLIF and PLIF. Forest plots were constructed for each analysis group.Results
A total of 192 studies were identified; nine studies were included (one randomized controlled trial and eight case series), including 990 patients (450 TLIF and 540 PLIF). The pooled mean difference in postoperative Oswestry Disability Index (ODI) scores between TLIF and PLIF was ?3.46 (95% confidence interval [CI] ?4.72 to ?2.20, p≤.001). The pooled mean difference in the postoperative VAS scores was ?0.05 (95% CI ?0.18 to 0.09, p=.480). The overall complication rate was 8.7% (range 0%–25%) for TLIF and 17.0% (range 4.7–28.8%) for PLIF; the pooled odds ratio was 0.47 (95% CI 0.28–0.81, p=.006). The average duration of surgery was 169 minutes for TLIF and 190 minutes for PLIF (mean difference ?20.1, 95% CI ?33.5 to ?6.6, p=.003). The estimated blood loss was 350?mL for TLIF and 418?mL for PLIF (mean difference ?43.9?mL, 95% CI ?71.2 to ?16.6, p=.002).Conclusions
TLIF has advantages over PLIF in the complication rate, blood loss, and operation duration. The clinical outcome is similar, with a slightly lower postoperative ODI score for TLIF. 相似文献2.
Jay M. Levin Joseph E. Tanenbaum Michael P. Steinmetz Thomas E. Mroz Samuel C. Overley 《The spine journal》2018,18(6):1088-1098
Background Context
Lumbar fusion is an effective and durable treatment for symptomatic lumbar spondylolisthesis; however, the current literature provides insufficient evidence to recommend an optimal surgical fusion strategy.Purpose
The present study aims to compare the clinical outcomes, fusion rates, blood loss, and operative times between open posterolateral lumbar fusion (PLF) alone and open transforaminal lumbar interbody fusion (TLIF)?+?posterolateral fusion for spondylolisthesis.Study Design
This is a systematic literature review and meta-analysis of English language studies for the treatment of spondylolisthesis with PLF versus PLF?+?TLIF.Patient Sample
Data were obtained from published randomized controlled trials (RCTs) and retrospective cohort studies.Outcome Measures
Clinical outcomes included Oswestry Disability Index (ODI), back pain, leg pain, and health-related quality of life (HRQOL) scores. Fusion rate, operative time, blood loss, and infection rate were also assessed.Methods
A literature search of three electronic databases was performed to identify investigations performed comparing PLF alone with PLF?+?TLIF for treatment of low-grade lumbar spondylolisthesis. The summary effect size was assessed from pooling observational studies for each of the outcome variables, with odds ratios (ORs) used for fusion and infection rate, mean difference used for improvement in ODI and leg pain as well as operative time and blood loss, and standardized mean difference used for improvement in back pain and HRQOL outcomes. Studies were weighed based on the inverse of the variance and heterogeneity. Heterogeneity was assessed using the I2—an estimate of the error caused by between-study variation. Effect sizes from the meta-analysis were then compared with data from the RCTs to assess congruence in outcomes.Results
The initial literature search yielded 282 unique, English language studies. Seven were determined to meet our inclusion criteria and were included in our qualitative analysis. Five observational studies were included in our quantitative meta-analysis. The pooled fusion success rates were 84.7% (100/118) in the PLF group and 94.3% (116/123) in the TLIF group. Compared with TLIF patients, PLF patients had significantly lower odds of achieving solid arthrodesis (OR 0.33, 95% confidence interval [CI] 0.13–0.82, p=.02; I2=0%). With regard to improvement in back pain, the point estimate for the effect size was ?0.27 (95% CI ?0.43 to ?0.10, p=.002; I2=0%), in favor of the TLIF group. For ODI, the pooled estimate for the effect size was ?3.73 (95% CI ?7.09 to ?0.38, p=.03; I2=35%), significantly in favor of the TLIF group. Operative times were significantly shorter in the PLF group, with a summary effect size of ?25.55 (95% CI ?43.64 to ?7.45, p<.01; I2=54%). No significant difference was observed in leg pain, HRQOL improvement, blood loss, or infection rate. Our meta-analysis results were consistent with RCTs, in favor of TLIF for achieving radiographic fusion and greater improvement in ODI and back pain.Conclusions
Our results demonstrate that for patients undergoing fusion for spondylolisthesis, TLIF is superior to PLF with regard to achieving radiographic fusion. However, current data only provide weak support, if any, favoring TLIF over PLF for clinical improvement in disability and back pain. 相似文献3.
Xiaofei Cheng Kai Zhang Xiaojiang Sun Changqing Zhao Hua Li Bin Ni Jie Zhao 《The spine journal》2017,17(8):1127-1133
Background Context
Laminectomy with posterior lumbar interbody fusion (PLIF) has been shown to achieve satisfactory clinical outcomes, but it leads to potential adverse consequences associated with extensive disruption of posterior bony and soft tissue structures.Purpose
This study aimed to compare the clinical and radiographic outcomes of bilateral decompression via a unilateral approach (BDUA) with transforaminal lumbar interbody fusion (TLIF) and laminectomy with PLIF in the treatment of degenerative lumbar spondylolisthesis (DLS) with stenosis.Study Design
This is a prospective cohort study.Patient Sample
This study compared 43 patients undergoing BDUA+TLIF and 40 patients undergoing laminectomy+PLIF.Outcome Measures
Visual analog scale (VAS) for low back pain and leg pain, Oswestry Disability Index (ODI), and Zurich Claudication Questionnaire (ZCQ) score.Methods
The clinical outcomes were assessed, and intraoperative data and complications were collected. Radiographic outcomes included slippage of the vertebra, disc space height, segmental lordosis, and final fusion rate. This study was supported by a grant from The National Natural Science Foundation of China (81572168).Results
There were significant improvements in clinical and radiographic outcomes from before surgery to 3 months and 2 years after surgery within each group. Analysis of leg pain VAS and ZCQ scores showed no significant differences in improvement between groups at either follow-up. The mean improvements in low back pain VAS and ODI scores were significantly greater in the BDUA+TLIF group than in the laminectomy+PLIF group. No significant difference was found in the final fusion rate at 2-year follow-up. The BDUA+TLIF group had significantly less blood loss, shorter length of postoperative hospital stay, and lower complication rate compared with the laminectomy+PLIF group.Conclusions
When compared with the conventional laminectomy+PLIF procedure, the BDUA+TLIF procedure achieves similar and satisfactory effects of decompression and fusion for DLS with stenosis. The BDUA+TLIF procedure appears to be associated with less postoperative low back discomfort and quicker recovery. 相似文献4.
Swamy Kurra William F. Lavelle Michael P. Silverstein Jason W. Savage R. Douglas Orr 《The spine journal》2018,18(6):1014-1021
Background Context
Patients with spinal deformity may present with complaints related to either the deformity itself or the manifestations of the coexisting spinal stenosis. There are reports of successful management of lumbar pathology in the absence of global sagittal or coronal imbalance, with limited decompression and fusion, addressing only the symptomatic segment.Purpose
Our study examined the long-term outcomes of transforaminal lumbar interbody fusion (TLIF), a less extensive procedure, based on the experience of the senior author over the past 10 years.Study Design/Setting
This was a retrospective study of symptomatic lumbar spinal stenosis and spinal deformity managed by one surgeon at The Cleveland Clinic since 2003.Patient Sample
Forty-one patients were included in the study.Outcome Measures
The present study measures the long-term clinical functional outcomes of these patients through EQ-5D (EuroQol five dimensions questionnaire), PHQ-9 (Patient Health Questionnaire), and PDQ (Pain Disability Questionnaire) forms, along with documented radiographic parameters and Charlson Comorbidity Index (CCI).Methods
There were no funding or potential conflicts of interest associated biases in the present study. Patients with symptomatic lumbar spinal stenosis with neutral global alignment in the sagittal and coronal planes and symptomatic stenosis at the deformity level were treated by limited fusion and TLIF, and had a follow-up period of at least 5 years. Excluded were patients under 18 years of age, had more than three levels of fusion, and had an active spinal malignancy or recent spinal trauma. The grouping variables were curve magnitude, revision surgeries, and TLIF levels. Clinical outcomes were compared in all the grouping variables. Analysis of variance (ANOVA) and chi-square tests were utilized; p<.05 was considered statistically significant.Results
The average age and follow-up period were 66±10 and 7.5 years, respectively. There was no statistical difference between patients with curves measuring between 10° and 20° and greater than 20° for EQ-5D, PHQ-9, and PDQ. Patients had worse PDQ data with larger curves compared with smaller curves at both 5 years and final follow-up. Although there was no statistical significance between preoperative coronal curve magnitude and revision surgeries, patients with curves greater than 20° had higher rates of revision surgeries (75%; p=.343) in the global lumbar curve deformity group. Although there was no statistical significance for patients who underwent revision surgeries,those patients had low PHQ-9 values at the final follow-up (p=.09). The revision surgery rate was 48% in one-level TLIF and 18% in two-level TLIF. Moderate pain disability scores were noticed for one-level TLIF patients (mean=75) compared with two-level TLIF patients (mean=27) at the final follow-up, and approached statistical significance in this comparison (p=.06).Conclusion
Although this topic has a limited audience to spinal deformity surgeons, the prevalence of patients who present with adult spinal deformities has been increasing. Short segment fusion, in the setting of modest spinal deformity, is a reasonable and safe option. Further study on the concept of short segment fusions in the growing patient population is required as more comprehensive fusions do have noted complication rates, and a compromise must be reached between the extent of surgery that is enough to provide pain relief and disability and the degree of surgery that is too much to be tolerated in terms of complication rates. 相似文献5.
Philip K. Louie Arya G. Varthi Ankur S. Narain Victor Lei Daniel D. Bohl Grant D. Shifflett Frank M. Phillips 《The spine journal》2018,18(11):2025-2032
Background Context
Revision posterior decompression and fusion surgery for patients with symptomatic adjacent segment degeneration (ASD) is associated with significant morbidity and is technically challenging. The use of a stand-alone lateral lumbar interbody fusion (LLIF) in patients with symptomatic ASD may prevent many of the complications associated with revision posterior surgery.Purpose
The objective of this study was to assess the clinical and radiographic outcomes of patients who underwent stand-alone LLIF for symptomatic ASD.Study Design
This is a retrospective case series.Patient Sample
We retrospectively reviewed patients with a prior posterior instrumented fusion who underwent a subsequent stand-alone LLIF for ASD by a single surgeon. All patients had at least 18 months of follow-up. Patients were diagnosed with symptomatic ASD if they had a previous lumbar fusion with the subsequent development of back pain, neurogenic claudication, or lower extremity radiculopathy in the setting of imaging, which demonstrated stenosis, spondylolisthesis, kyphosis, or scoliosis at the adjacent level.Outcome Measures
Patient-reported outcomes were obtained at preoperative and final follow-up visits using the Oswestry Disability Index [ODI], visual analog scale (VAS)—back, and VAS—leg. Radiographic parameters were measured, including segmental and overall lordoses, pelvic incidence-lumbar lordosis mismatch, coronal alignment, and intervertebral disc height.Methods
Clinical and radiographic outcomes were compared between preoperative and final follow-up using paired t tests.Results
Twenty-five patients met inclusion criteria. The mean age was 62.0±11.3 years. The average follow-up was 34.8±22.4 months. Fifteen (60%) underwent stand-alone LLIF surgery for radicular leg pain, 7 (28%) for symptoms of claudication, and 25 (100.0%) for severe back pain. Oswestry Disability Index scores significantly improved from preoperative values (46.6±16.4) to final follow-up (30.4±16.8, p=.002). Visual analog scale—back (preop 8.4±1.0, postop 3.2±1.9; p<.001), and VAS—leg (preop 3.6±3.4, postop 1.9±2.6; p<.001) scores significantly improved following surgery. Segmental and regional lordoses, as well as intervertebral disc height, significantly improved (p<.001) and remained stable (p=.004) by the surgery. Pelvic incidence-lumbar lordosis mismatch significantly improved at the first postoperative visit (p=.029) and was largely maintained at the most recent follow-up (p=.45). Six patients suffered from new-onset thigh weakness following LLIF surgery, but all showed complete resolution within 6 weeks. Three patients required subsequent additional surgeries, all of which were revised to include posterior instrumentation.Conclusions
Stand-alone LLIF is a safe and effective approach with low morbidity and acceptable complication rates for patients with symptomatic ASD following a previous lumbar fusion. 相似文献6.
Meng-Huang Wu Navneet Kumar Dubey Yen-Yao Li Ching-Yu Lee Chin-Chang Cheng Chung-Sheng Shi Tsung-Jen Huang 《The spine journal》2017,17(8):1082-1090
Background Context
To date, the surgical approaches for the treatment of lumbar spondylolisthesis by transforaminal lumbar interbody fusion (TLIF) using minimally invasive spine surgery assisted with intraoperative computed tomography image-integrated navigation (MISS-iCT), fluoroscopy (MISS-FS), and conventional open surgery (OS) are debatable.Purpose
This study compared TLIF using MISS-iCT, MISS-FS, and OS for treatment of one-level lumbar spondylolisthesis.Study Design
This is a prospective, registry-based cohort study that compared surgical approaches for patients who underwent surgical treatment for one-level lumbar spondylolisthesis.Patient Sample
One hundred twenty-four patients from January 2010 to March 2012 in a medical center were recruited.Outcome Measures
The outcome measures were clinical assessments, including Short-Form 12, visual analog scale (VAS), Oswestry Disability Index, Core Outcome Measurement Index, and patient satisfaction, and blood loss, hospital stay, operation time, postoperative pedicle screw accuracy, and superior-level facet violation.Methods
All surgeries were performed by two senior surgeons together. Ninety-nine patients (40M, 59F) who had at least 2 years' follow-up were divided into three groups according to the operation methods: MISS-iCT (N=24), MISS-FS (N=23), and OS (N=52) groups. Charts and surgical records along with postoperative CT images were assessed.Results
MISS-iCT and MISS-FS demonstrated a significantly lowered blood loss and hospital stay compared with OS group (p<.01). Operation time was significantly lower in the MISS-iCT and OS groups compared with the MISS-FS group (p=.002). Postoperatively, VAS scores at 1 year and 2 years were significantly improved in the MISS-iCT and MISS-FS groups compared with the OS groups. No significant difference in the number of pedicle screw breach (>2?mm) was found. However, a lower superior-level facet violation rate was observed in the MISS-iCT and OS groups (p=.049).Conclusions
MISS-iCT TLIF demonstrated reduced operation time, blood loss, superior-level facet violation, hospital stay, and improved functional outcomes compared with the MISS-FS and OS approaches. 相似文献7.
Erik Y. Tye Joseph E. Tanenbaum Andrea S. Alonso Roy Xiao Michael P. Steinmetz Thomas E. Mroz Jason W. Savage 《The spine journal》2018,18(3):464-471
Background Context
Transforaminal lumbar interbody fusion (TLIF) or anterior lumbar interbody fusion with percutaneous pedicle screws (ALIFPS) offer significantly higher radiographic fusion rates than other fusion techniques for L5–S1 isthmic spondylolisthesis (IS). As it stands, there is a relative paucity of comparative data of the two techniques.Purpose
To define the clinical, radiographic, and financial differences between TLIF and ALIFPS for L5–S1 IS.Design/Setting
A retrospective cohort study conducted at a single tertiary care center.Patient Sample
Sixty-six patients who underwent either TLIF or ALIPFS for L5–S1 IS at a single tertiary care center between 2009 and 2014.Outcome Measures
Quality of life outcome scores including the EuroQol-5 Dimensions (EQ-5D), Pain Disability Questionnaire (PDQ), and Patient Health Questionnaire-9 (PHQ-9). Sagittal balance parameters including: pelvic incidence, pelvic tilt, sacral slope, segmental lordosis, total lordosis, degree of slip, disc height, and L1-axis S1 distance (LASD). Cost measures included in-hospital charges, hospital length of stay (LOS), and post-admission costs accrued over 1 year.Methods
Quality of life (QoL) outcome scores, radiographic data, and financial data were collected with a minimum of 1-year follow-up. Clinical results were investigated using the PDQ, PHQ-9, and EQ-5D. Radiographic measurements included lumbar lordosis, segmental lordosis, pelvic tilt, pelvic incidence, height of disc, L-1 axis S-1 distance, and the degree of slip. Cost data were generated based on patient-level resource utilization. Comparative data were presented as median with interquartile range (IQR). Continuous variables were compared using either independent Student t tests assuming unequal variance or Mann-Whitney U tests for parametric and nonparametric variables, respectively. The minimally clinical important difference (MCID) used for each questionnaire was as follows: PDQ (26), PHQ-9 (5), and EQ-5D (0.4).Results
A total of 66 patients met inclusion criteria. In the ALIFPS cohort, PDQ scores improved from 69 [47, 82] to 26 [18.2, 79.7], p=.02. In the TLIF cohort, PDQ scores improved from 73 [46, 85] to 48.5 [23, 67.5], p=.01. Both groups also showed a significant improvement in EQ-5D scores at 1 year, but the ALIFPS group showed a significantly greater improvement in EQ-5D scores at 1 year (0.1 [0,0.2] vs. 0.2 [0.1, 0.4], p=.02). Furthermore, only the ALIFPS cohort showed a significant improvement in segmental lordosis. The ALIFPS cohort showed a significantly greater improvement in disc height than did TLIF (3.5 [2, 5.5] vs. 6.7 [4.1, 10], p=.01). No significant differences were found in the direct costs of both procedures.Conclusions
Our findings suggest that anterior lumbar interbody fusion with percutaneous pedicle screws can achieve better clinical outcomes compared with TLIF for the treatment of IS. We believe the superior radiographic outcomes achieved through ALIFPS, namely a greater restoration of segmental lordosis and disc height, may have contributed to the improved clinical outcomes presented in the current study. 相似文献8.
Melodie F. Metzger Samuel T. Robinson Ruben C. Maldonado Jeremy Rawlinson John Liu Frank L. Acosta 《The spine journal》2017,17(7):1004-1011
Background Context
Surgical treatment of symptomatic adjacent segment disease (ASD) typically involves extension of previous instrumentation to include the newly affected level(s). Disruption of the incision site can present challenges and increases the risk of complication. Lateral-based interbody fusion techniques may provide a viable surgical alternative that avoids these risks. This study is the first to analyze the biomechanical effect of adding a lateral-based construct to an existing fusion.Purpose
The study aimed to determine whether a minimally invasive lateral interbody device, with and without supplemental instrumentation, can effectively stabilize the rostral segment adjacent to a two-level fusion when compared with a traditional posterior revision approach.Study Design/Setting
This is a cadaveric biomechanical study of lateral-based interbody strategies as add-on techniques to an existing fusion for the treatment of ASD.Methods
Twelve lumbosacral specimens were non-destructively loaded in flexion, extension, lateral bending, and torsion. Sequentially, the tested conditions were intact, two-level transforaminal lumbar interbody fusion (TLIF) (L3–L5), followed by lateral lumbar interbody fusion procedures at L2–L3 including interbody alone, a supplemental lateral plate, a supplemental spinous process plate, and then either cortical screw or pedicle screw fixation. A three-level TLIF was the final instrumented condition. In all conditions, three-dimensional kinematics were tracked and range of motion (ROM) was calculated for comparisons. Institutional funds (<$50,000) in support of this work were provided by Medtronic Spine.Results
The addition of a lateral interbody device superadjacent to a two-level fusion significantly reduced motion in flexion, extension, and lateral bending (p<.05). Supplementing with a lateral plate further reduced ROM during lateral bending and torsion, whereas a spinous process plate further reduced ROM during flexion and extension. The addition of posterior cortical screws provided the most stable lateral lumbar interbody fusion construct, demonstrating ROM comparable with a traditional three-level TLIF.Conclusions
The data presented suggest that a lateral-based interbody fusion supplemented with additional minimally invasive instrumentation may provide comparable stability with a traditional posterior revision approach without removal of the existing two-level rod in an ASD revision scenario. 相似文献9.
Taleef R. Khan Kalin R. Pearce Steven J. McAnany Colleen M. Peters Munish C. Gupta Lukas P. Zebala 《The spine journal》2018,18(3):439-446
Background Context
Recombinant human bone morphogenetic protein 2 (rhBMP-2) plays a pivotal role in complex spine surgery. Despite its limited approval, the off-label use of rhBMP-2 is prevalent, particularly in transforaminal lumbar interbody fusions (TLIFs).Purpose
To determine the effectiveness and safety of rhBMP-2 use in TLIF procedures versus autograft.Study Design
Retrospective cohort study.Patient Sample
Patients older than 18 years undergoing spine surgery for lumbar degenerative spine disease at a single academic institution.Outcome Measures
Clinical outcome was determined according to patient records. Radiographic outcome was determined according to plain X-rays and computed tomography (CT).Methods
A retrospective study from 1997 to 2014 was conducted on 191 adults undergoing anterior-posterior instrumented spinal fusion with TLIF at a single academic institution. Patient data were gathered from operative notes, follow-up clinic notes, and imaging studies to determine complications and fusion rates. One hundred eighty-seven patients fit the criteria, which included patients with a minimum of one TLIF, and had a minimum 2-year radiographic and clinical follow-up. Patients were further classified into a BMP group (n=83) or non-BMP group (n=104). Three logistic regression models were run using rhBMP-2 exposure as the independent variable. The respective outcome variables were TLIF-related complications (radiculitis, seroma, osteolysis, and ectopic bone), surgical complications, and all complications.Results
Bone morphogenetic protein (n=83) and non-BMP (n=104) groups had similar baseline demographics (sex, diabetes, pre-existing cancer). On average, the BMP and non-BMP groups were similarly aged (51.9 vs. 47.9 years, p>.05), but the BMP group had a shorter follow-up time (3.03 vs. 4.06 years; p<.001) and fewer smokers (8 vs. 21 patients; p<.048). The fusion rate for the BMP and non-BMP groups was 92.7% and 92.3%, respectively. The pseudoarthrosis rate was 7.5% (14 of 187 patients). Radiculitis was observed in seven patients in the BMP group (8.4%) and two patients in the non-BMP group (1.9%). Seroma was observed in two patients in the BMP group (2.4%) and none in the non-BMP group. No deep infections were observed in the BMP group, and in one patient in the non-BMP group (0.96%). Although patients exposed to BMP were at a significantlygreater risk of developing radiculitis and seroma (odds ratio [OR]=4.53, confidence interval [CI]=1.42–14.5), BMP exposure was not a significant predictor of surgical complications (OR=0.32, CI=0.10–1.00) or overall complications (OR=1.11, CI=0.53–2.34). The outcome of TLIF-related complications was too rare and the confidence interval too wide for practical significance of the first model.Conclusion
Evidence supports the hypothesis that off-label use of rhBMP-2 in TLIF procedures is relatively effective for achieving bone fusion at rates similar to patients receiving autograft. Patients exhibited similar complication rates between the two groups, with the BMP group exhibiting slightly higher rates of radiculitis and seroma. 相似文献10.
Vincent J. Alentado Stephanie Caldwell Heath P. Gould Michael P. Steinmetz Edward C. Benzel Thomas E. Mroz 《The spine journal》2017,17(2):236-243
Background Context
Multiple studies have determined minimum clinically important difference (MCID) thresholds for EuroQOL-5 Dimensions (EQ-5D) scores in lumbar fusion patients. However, a comprehensive understanding of predictors for a clinically significant improvement (CSI) postoperatively does not exist.Purpose
To determine medical, radiographic, and surgical predictors for obtaining a CSI following lumbar fusion surgery.Study Design
This is a retrospective review of patients who underwent instrumented lumbar fusion.Patient Sample
We included patients who underwent lumbar fusion for any indication between 2008 and 2013.Outcome Measures
Outcome measures included preoperative and postoperative EQ-5D Index scores.Materials and Methods
The medical records of patients who received a lumbar fusion for any indication were retrospectively reviewed to identify patient medical and surgical characteristics. A blinded reviewer assessed radiographs for each patient to examine sagittal alignment following fusion. Multivariable logistic regression was used to model the achievement of a CSI based on two commonly cited MCID values.Results
A total of 231 patients fit the inclusion criteria; 58% exceeded an MCID value for an EQ-5D score of 0.100, and 16% exceeded an MCID value of 0.390. Statistically significant independent predictors of not obtaining a CSI for an MCID threshold of 0.100 included a higher preoperative EQ-5D score (odds ratio [OR]=44.8) and L5-S1 fusion (OR=3.3). For an MCID value of 0.390, a higher preoperative EQ-5D score (OR=2,080.8) and a diagnosis of depression (OR=7.1) were predictive of not achieving a CSI, whereas spondylolisthesis (OR=4.1) was predictive of obtaining a CSI postoperatively. For both MCID values, patients who achieved a CSI had better postoperative quality of life (QOL) scores for all metrics measured, despite worse QOL scores preoperatively.Conclusions
This study is the first to use a combination of medical, surgical, and postoperative sagittal balance variables as determinants for the achievement of a CSI after lumbar fusion. The awareness of these predictors may allow for better patient selection and surgical approach to decrease the probability of acquiring a poor outcome postoperatively. 相似文献11.
Background Context
The influence of rheumatoid arthritis (RA) on the lumbar spine has received relatively little attention compared with cervical spine, and few studies have been conducted for adjacent segment disease (ASD) after lumbar fusion in patients with RA.Purpose
The present study aims to determine the incidence of ASD requiring surgery (ASDrS) after short lumbar fusion and to evaluate risk factors for ASDrS, including RA.Study Design
This is a retrospective cohort study.Patient Sample
The present study included 479 patients who underwent lumbar spinal fusion of three or fewer levels, with the mean follow-up period of 51.2 (12–132) months.Outcome Measures
The development of ASD and consequent revision surgery were reviewed using follow-up data.Methods
The ASDrS-free survival rate of adjacent segments was calculated through Kaplan-Meier method. The log-rank test and Cox regression analysis were used to evaluate risk factors comprising RA, age, gender, obesity, osteoporosis, diabetes, smoking, surgical method, and the number of fusion segments.Results
After short lumbar fusion, revision surgery for ASD was performed in 37 patients (7.7%). Kaplan-Meier analysis predicted that the ASDrS-free survival rate of adjacent segments was 97.8% at 3 years, 92.7% at 5 years, and 86.8% at 7 years. In risk factor analysis, patients with RA showed a 4.5 times higher risk of ASDrS than patients without RA (p<.001), and patients with three-segment fusion showed a 2.7 times higher risk than patients with one- or two-segment fusion (p=.005).Conclusions
Adjacent segment disease requiring surgery was predicted in 13.2% of patients at 7 years after short lumbar fusion. Rheumatoid arthritis and the number of fusion segments were confirmed as risk factors. 相似文献12.
Jae Hwan Cho Youn-Suk Joo Cheongsu Lim Chang Ju Hwang Dong-Ho Lee Choon Sung Lee 《The spine journal》2017,17(12):1794-1802
Background Context
Sagittal imbalance is associated with poor clinical outcomes in patients with degenerative lumbar disease. However, there is no consensus on the impact of posterior lumbar interbody fusion (PLIF) on local and global sagittal balance.Purpose
To reveal the effect of one- or two-level PLIF on global sagittal balance.Design/Setting
A retrospective case-control study.Patients Sample
This study included 88 patients who underwent a one- or two-level PLIF for spinal stenosis with spondylolisthesis.Outcome Measures
Clinical and radiological parameters were measured pre- and postoperatively.Methods
All patients were followed up for >2 years. Clinical outcomes included a visual analog scale, Oswestry Disability Index, and EuroQol 5-dimension questionnaire (EQ-5D). Radiological parameters were measured using whole-spine standing lateral radiographs. Fusion, loosening, subsidence rates, and adverse events were also evaluated. Patients were divided into two groups according to their preoperative C7–S1 sagittal vertical axis (SVA): Group N: SVA≤5?cm vs Group I: SVA>5?cm; they were also divided according to postoperative changes in C7–S1 SVA. Clinical and radiological outcomes were compared between the groups.Results
All clinical outcomes and radiological parameters improved postoperatively. C7–S1 SVA improved (?1.6?cm) after L3–L5 fusion, but it was compromised (+3.6?cm) after L4–S1 fusion (p=.001). Preoperative demographic and clinical data showed no difference except in the anxiety or depression domain of EQ-5D. No differences were found in postoperative clinical outcomes. Lumbar lordosis, pelvic tilt, and thoracic kyphosis slightly improved in Group N, whereas C7–S1 SVA decreased from 9.5?cm to 3.8?cm (p<.001) in Group I. Furthermore, all sagittal parameters improved in Group I. On comparing the postoperative changes in C7–S1 SVA, we found that the decreasing trend in the postoperative C7–S1 SVA was related to a larger preoperative C7–S1 SVA (p=.030) and a more proximal level fusion (L3–L5 vs L4–S1, p=.033).Conclusions
Global sagittal balance improved after short-level lumbar fusion surgery in patients having spinal stenosis with spondylolisthesis who showed preoperative sagittal imbalance. Restoration of sagittal balance predominantly occurred after L3–L4, L4–L5, or L3–L5 PLIF. However, no such restoration was observed after L5–S1 or L4–S1 PLIF. Thus, we could anticipate sagittal balance restoration after performing PLIF at L3–L4 or L4–L5 level. However, caution is required when planning for L5–S1 fusion if preoperative sagittal imbalance is present. 相似文献13.
Deeptee Jain Sigurd H. Berven John Carter Alan L. Zhang Vedat Deviren 《The spine journal》2018,18(9):1526-1532
Background context
Severely obese patients with operative spinal pathology present a challenge to the spine surgeon, given the increased complication risk.Purpose
We aimed to determine the impact of bariatric surgery (BS) on perioperative complications of posterior lumbar fusion.Study Design
This is a retrospective cohort study.Patient Sample
Patients undergoing posterior lumbar fusion surgery in the State Inpatient Databases of New York, Florida, North Carolina, Nebraska, Utah, and California comprised the patient sample.Outcomes
Thirty-day medical complications, surgical complications (nerve injury, infection, revision), death, readmission, and hospital length of stay (LOS) were the study's outcomes.Methods
We analyzed 156,517 patients using International Classification of Diseases, Ninth Revision codes. Patients were categorized into three groups: Group 1: history of BS and obesity, Group 2: severe obesity, body mass index (BMI)>40 (severely obese), and Group 3: normal weight, BMI<25 (non-obese). Logistic and linear multivariate regressions were performed to compare complications and LOS, respectively, between BS and severely obese groups and BS and non-obese groups while controlling for confounders. There were no sources of funding for this study.Results
There were 590 patients with BS, 5,791 severely obese, and 150,136 non-obese. Comparing BS with severely obese, BS had significantly lower rates of respiratory failure (odds ratio [OR] 0.59, p=.019), urinary tract infection (OR 0.64, p=.031), acute renal failure (OR 0.39, p=.007), overall medical complications (OR 0.59, p<.001), and infection (OR 0.65, p=.025). Bariatric surgery also had significantly lower hospital LOS (B=?0.46, p=.01). Comparing BS with non-obese, there were no significant differences in medical complications; however, BS had significantly higher rates of infection (OR 2.70, p<.001), reoperation (OR 2.05, p=.045), and readmission (OR 1.89, p<.001).Conclusion
Bariatric surgery before elective posterior lumbar fusion mitigates risk of medical complications and infection. However, these patients still have increased risk of infection, revision surgery, and readmission compared with patients with normal BMI. Surgeons might consider referral for BS for the severely obese patient before undergoing spine surgery. 相似文献14.
Jan Triebel Greta Snellman Bengt Sandén Fredrik Strömqvist Yohan Robinson 《The spine journal》2017,17(5):656-662
Background Context
Proper patient selection is of utmost importance in the surgical treatment of degenerative disc disease (DDD) with chronic low back pain (CLBP). Among other factors, gender was previously found to influence lumbar fusion surgery outcome.Purpose
This study investigates whether gender affects clinical outcome after lumbar fusion.Study Design
This is a national registry cohort study.Patient sample
Between 2001 and 2011, 2,251 men and 2,521 women were followed prospectively within the Swedish National Spine Register (SWESPINE) after lumbar fusion surgery for DDD and CLBP.Outcome measures
Patient-reported outcome measures (PROMs), visual analog scale (VAS) for leg and back pain, Oswestry Disability Index (ODI), quality of life (QoL) parameter EQ5D, and labor status and pain medication were collected preoperatively, 1 and 2 years after surgery.Methods
Gender differences of baseline data and PROM improvement from baseline were analyzed. The effect of gender on clinically important improvement of PROM was determined in a multivariate logistic regression model. Furthermore, gender-related differences in return-to-work were investigated.Results
Preoperatively, women had worse leg pain (p<.001), back pain (p=.002), lower QoL (p<.001), and greater disability than men (p=.001). Postoperatively, women presented greater improvement 2 years from baseline for pain, function, and QoL (all p<.01). Women had better chances of a clinically important improvement than men for leg pain (odds ratio [OR]=1.39, 95% confidence interval [CI]: 1.19–1.61, p<.01) and back pain (OR=1.20,95% CI:1.03–1.40, p=.02) as well as ODI (OR=1.24, 95% CI:1.05–1.47, p=.01), but improved at a slower pace in leg pain (p<.001), back pain (p=.009), and disability (p=.008). No gender differences were found in QoL and return to work at 2 years postoperatively.Conclusions
Swedish women do not have worse results than men after spinal fusion surgery. Female patients present with worse pain and function preoperatively, but improve more than men do after surgery. 相似文献15.
Victor E. Staartjes Pieter-Paul A. Vergroesen Dick J. Zeilstra Marc L. Schröder 《The spine journal》2018,18(4):558-566
Background Context
Fusion surgery for degenerative disc disease (DDD) has become a standard of care, albeit not without controversy. Outcomes are inconsistent and a superiority over conservative treatment is debatable. Proper patient selection is key to clinical success, and a comprehensive understanding of prognostic tests does not currently exist.Purpose
This study aimed to investigate the value of prognostic tests and sociodemographic factors in predicting outcomes following lumbar fusion surgery for DDD.Study Design
This is a retrospective analysis of prospectively collected data.Patient Sample
We included patients who underwent fusion surgery for DDD between 2010 and 2016.Outcome Measures
The outcome measures included pre- and postoperative visual analog scale and Oswestry Disability Index scores.Materials and Methods
Prospectively collected patient data were reviewed for preoperative tests, perioperative data, and clinical outcomes. Prognostic tests used were discography, pantaloon cast test (PCT), Modic changes, and a summary of physical symptoms, coined “loading factor.” By means of multivariate stepwise regression, prognostic factors that were useful in predicting outcomes were identified.Results
A total of 91 patients fit the inclusion criteria, with a mean follow-up of 33±16 months. Discography, Modic changes, and loading factor were of no value for predicting outcome scores (p>.05). A positive PCT predicted improved outcomes in back pain severity, but only in patients without prior surgery (p=.02). Demographic factors that showed a consistent reduction in back pain were female sex (p=.021) and no prior surgery at index level (p=.009). No other sociodemographic factors were of predictive value (p>.05).Conclusions
In patients without prior surgery, the PCT appears to be the most promising prognostic tool. Other prognostic selection tools such as discography and Modic changes yield disappointing results. In this study, female patients and those without prior spine surgery appear to be most likely to benefit from fusion surgery for DDD. 相似文献16.
Wesley M. Durand Joseph R. Johnson Neill Y. Li JaeWon Yang Adam E.M. Eltorai J. Mason DePasse Alan H. Daniels 《The spine journal》2018,18(4):626-631
Background Context
Interhospital competition has been shown to influence the adoption of surgical techniques and approaches, clinical patient outcomes, and health care resource use for select surgical procedures. However, little is known regarding these dynamics as they relate to spine surgery.Purpose
This investigation sought to examine the relationship between interhospital competitive intensity and perioperative outcomes following lumbar spinal fusion.Study Design/Setting
This study used the Nationwide Inpatient Sample dataset, years 2003, 2006, and 2009.Patient Sample
Patients were included based on the presence of the International Classification of Disease, Ninth Edition, Clinical Modification (ICD-9-CM) codes corresponding to lumbar spinal fusion, as well as on the presence of data on the Herfindahl-Hirschman Index (HHI).Outcome Measures
The outcome measures are perioperative complications, defined using an ICD-9-CM coding algorithm.Materials and Methods
The HHI, a validated measure of competition within a market, was used to assess hospital market competitiveness. The HHI was calculated based on the hospital cachement area. Multiple regression was performed to adjust for confounding variables including patient age, gender, primary payer, severity of illness score, primary versus revision fusion, anterior versus posterior approach, national region, hospital bed size, location or teaching status, ownership, and year. Perioperative clinical outcomes were assessed based on ICD-9-CM codes with modifications.Results
In total, 417,520 weighted patients (87,999 unweighted records) were analyzed. The mean cachement area HHI was 0.31 (range 0.099–0.724). The average patient age was 55.4 years (standard error=0.194), and the majority of patients were female (55.8%, n=232,727). The majority of procedures were primary spinal fusions (92.7%, n=386,998) and fusions with a posterior-only technique (81.5%, n=340,271). Most procedures occurred in the South (42.5%, n=177,509) or the Midwest (27.0%, n=112,758) regions. In the multiple regression analysis, increased hospital competitive intensity was associated with an increased total complication rate (odds ratio [OR] 1.52, p<.0001), device-related complications (OR 1.46, p=.0294), genitourinary complications (OR 2.15, p=.0091), infection (OR 3.48, p<.0001), neurologic complications (OR 1.69, p=.0422), total charges (+29%, p=.0034), and inpatient hospital length of stay (LOS) (+16%, p=.0012). The likelihood of complications at state-owned hospitals (OR 2.81, p=.0001) was more highly associated with HHI than at private, non-profit hospitals (OR 1.39, p=.0050). The occurrence of complications at urban teaching hospitals (OR 2.14, p<.0001) was generally more associated with HHI than at urban non-teaching hospitals (OR 1.19, p=.2457).Conclusions
Increased interhospital competitive intensity is associated with increased odds of complications, increased total charges, and prolonged LOS following lumbar spine fusion. These differences are generally highest among state-owned and urban teaching hospitals. Differences in outcome related to hospital competition may be due to suboptimal resource allocation. Identifying differences in perioperative outcomes associated with hospital market competition is important in the contemporary environment of health care reimbursement reform and hospital consolidation. Perioperative outcome disparities between highly competitive and minimally competitive areas should be monitored and further studied. 相似文献17.
Seth Ahlquist Howard Y. Park Jonathan Gatto Ayra N. Shamie Don Y. Park 《The spine journal》2018,18(11):1999-2008
Background Context
Lumbar fusion is a popular and effective surgical option to provide stability and restore anatomy. Particular attention has recently been focused on sagittal alignment and radiographic spinopelvic parameters that apply to lumbar fusion as well as spinal deformity cases. Current literature has demonstrated the effectiveness of various techniques of lumbar fusion; however, comparative data of these techniques are limited.Purpose
This study aimed to directly compare the impact of various lumbar fusion techniques (anterior lumbar interbody fusion [ALIF], lateral lumbar interbody fusion [LLIF], transforaminal lumbar interbody fusion [TLIF], and posterolateral fusion [PLF]) based on radiographic parameters.Study Design/Setting
A single-center retrospective study examining preoperative and postoperative radiographs was carried out.Patient Sample
A consecutive list of lumbar fusion surgeries performed by multiple spine surgeons at a single institution from 2013 to 2016 was identified.Outcome Measures
Radiographic measurements used included segmental lordosis (SL), lumbar lordosis (LL), pelvic incidence (PI), pelvic incidence-lumbar lordosis (PI-LL) mismatch, anterior and posterior disc height (DH-A, DH-P, respectively), and foraminal height (FH).Methods
Radiographic measurements were performed on preoperative and postoperative lateral lumbar radiographs on all single-level lumbar fusion cases. Demographic data were collected including age, gender, approach, diagnosis, surgical level, and implant lordosis. Paired sample t test, one-way analysis of variance (ANOVA), McNemar test, and independent sample t test were used to establish significant differences in the outcome measures. Multiple linear regression was performed to determine a predictive model for lordosis from implant lordosis, fusion technique, and surgical level.Results
There were 164 patients (78 men, 86 women) with a mean age of 60.1 years and average radiographic follow-up time of 9.3 months. These included 34 ALIF, 23 LLIF, 63 TLIF, and 44 PLF surgeries. ALIF and LLIF significantly improved SL (7.9° and 4.4°), LL (5.5° and 7.7°), DH-A (8.8?mm and 5.8?mm), DH-P (3.4?mm and 2.3?mm), and FH (2.8?mm and 2.5?mm), respectively (p≤.003). TLIF significantly improved these parameters, albeit to a lesser extent: SL (1.7°), LL (2.7°), DH-A (1.1?mm), DH-P (0.8?mm), and FH (1.1?mm) (p≤.02). PLF did not significantly alter any of these parameters while significantly reducing FH (?1.3?mm, p=.01). One-way ANOVA showed no significant differences between ALIF and LLIF other than ALIF with greater ΔDH-A (3.0?mm, p=.02). Both ALIF and LLIF significantly outperformed PLF in preoperative to postoperative changes in all parameters p≤.001. Additionally, ALIF significantly outperformed TLIF in the change in SL (6.2°, p<.001), and LLIF significantly outperformed TLIF in the change in LL (5.0°, p=.02). Both outperformed TLIF in ΔDH-A (7.7?mm and 4.7?mm) and ΔDH-P (2.6?mm and 1.5?mm), respectively (p≤.02). ALIF was the only fusion technique that significantly improved the proportion of patients with a PI-LL<10° (0.410.66, p=.02). Lordotic cages had superior improvement of all parameters compared with non-lordotic cages (p<.001). Implant lordosis (m=1.1), fusion technique (m=6.8), and surgical level (m=6.9) significantly predicted postoperative SL (p<.001, R2=0.56).Conclusions
This study demonstrated that these four lumbar fusion techniques yield divergent radiographic results. ALIF and LLIF produced greater improvements in radiographic measurements postoperatively compared with TLIF and PLF. ALIF was the most successful in improving PI-LL mismatch, an important parameter relating to sagittal alignment. Lordotic implants provided better sagittal correction and surgeons should be cognizant of the impact that these differing implants and techniques produce after surgery. Surgical technique is an important determinant of postoperative alignment and has ramifications upon sagittal alignment in lumbar fusion surgery. 相似文献18.
Background Context
A variety of surgical methods are available for the treatment of adult isthmic spondylolisthesis, but there is no consensus regarding their relative effects on clinical outcomes.Purpose
To compare the effects of different surgical techniques on clinical outcomes in adult isthmic spondylolisthesis.Design
A systematic review was carried out.Patient Sample
A total of 1,538 patients from six randomized clinical trials (RCTs) and nine observational studies comparing different surgical treatments in adult isthmic spondylolisthesis.Outcome Measures
Primary outcome measures of interest included differences in pre- versus postsurgical assessments of pain, functional disability, and overall health as assessed by validated pain rating scales and questionnaires. Secondary outcome measures of interest included intraoperative blood loss, length of hospital stay, surgery duration, reoperation rates, and complication rates.Methods
A search of the literature was performed in September 2017 for relevant comparative studies published in the prior 10-year period in the following databases: PubMed, Embase, Web of Science, and ClinicalTrials.gov. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed and studies were included or excluded based on strict predetermined criteria. Quality appraisal was conducted using the Newcastle-Ottawa scale (NOS) for observational studies and the Cochrane Collaboration risk of bias assessment tool for RCTs. The authors received no funding support to conduct this review.Results
A total of 15 studies (six RCTs and nine observational studies) were included for full-text review, a majority of which only included cases of low-grade isthmic spondylolisthesis. One study examined the effects of adding pedicle screw fixation (PS) to posterolateral fusion (PLF) and two studies examined the effects of adding reduction to interbody fusion (IF)+PS on clinical outcomes. Five studies compared PLF, four with PS and one without PS, with IF+PS. Additionally, three studies compared circumferential fusion (IF+PS+PLF) with IF+PS and one study compared circumferential fusion with PLF+PS. Three studies compared clinical outcomes among different IF+PS techniques (anterior lumbar IF [ALIF]+PS vs. posterior lumbar IF [PLIF]+PS vs. transforaminal lumbar IF [TLIF]+PS) without PLF. As per the Cochrane Collaboration risk of bias assessment tool, four RCTs had an overall low risk of bias, one RCT had an unclear risk of bias, and one RCT had a high risk of bias. As per the NOS, three observational studies were of overall good quality, four observational studies were of fair quality, and two observational studies were of poor quality.Conclusions
Available studies provide strong evidence that the addition of reduction to fusion does not result in better clinical outcomes of pain and function in low-grade isthmic spondylolisthesis. Evidence also suggests that there is no significant difference between interbody fusion (IF+PS) and posterior fusion (PLF±PS) in outcomes of pain, function, and complication rates at follow-up points up to approximately 3 years in cases of low-grade slips. However, studies with longer follow-up points suggest that interbody fusion (IF+PS) may perform better in these same measures at later follow-up points. Available evidence also suggests no difference between circumferential fusion (IF+PS+PLF) and interbody fusion (IF+PS) in outcomes of pain and function in low-grade slips, but circumferential fusion has been associated with greater intraoperative blood loss, longer surgery duration, and longer hospital stays. In terms of clinical outcomes, insufficient evidence is available to assess the utility of adding PS to PLF, the relative efficacy of different interbody fusion (IF+PS) techniques (ALIF+PS vs. TLIF+PS vs. PLIF+PS), and the relative efficacy of circumferential fusion and posterior fusion (PLF+PS). 相似文献19.
Joseph E. Tanenbaum Stephanie T. Kha Edward C. Benzel Michael P. Steinmetz Thomas E. Mroz 《The spine journal》2018,18(7):1157-1165
Background Context
The United States Centers for Disease Control and Prevention estimates the prevalence of inflammatory bowel disease (IBD) at more than 3.1 million people. As diagnostic techniques and treatment options for IBD improve, the prevalence of IBD is expected to increase. For spine surgeons, patients with IBD have a unique complication profile because patients with IBD may present with poor nutritional status and because the medications used to manage IBD have been associated with poor vertebral bone mineralization and immunosuppression. Presently, there are very limited data regarding perioperative outcomes among patients with IBD who undergo spinal surgery. The present study begins to address this knowledge gap by describing trends in patients with IBD undergoing lumbar fusion and by quantifying the association between IBD and immediate postoperative outcomes using a large, national database.Purpose
To advance our understanding of the potential pitfalls and risks associated with lumbar fusion surgery in patients with IBD.Design/Setting
Retrospective cross-sectional analysis.Patient Sample
The Nationwide Inpatient Sample (NIS) database was queried from 1998 to 2011 to identify adult patients (18+) who underwent primary lumbar fusion operations using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) coding.Outcome Measures
Incidence of lumbar fusion procedures, prevalence of IBD, complication rates, length of stay, and total hospital charges.Methods
The annual number of primary lumbar fusion operations performed between 1998 and 2011 was obtained from the NIS database. Patients younger than 18 years of age were excluded. The prevalence of IBD in this population (both Crohn disease and ulcerative colitis) was determined using ICD-9-CM codes. Logistic regression models were estimated to determine the association between IBD and the odds of postoperative medical and surgical complications, while controlling for patient demographics, comorbidity burden, and hospital characteristics. The complex survey design of the NIS was taken into account by clustering on hospitals and assuming an exchangeable working correlation using the discharge weights supplied by the NIS. We accounted for multiple comparisons using the Bonferroni correction and an alpha level for statistical significance of . 0028.Results
The prevalence of IBD is increasing among patients undergoing lumbar fusion, from 0.21% of all patients undergoing lumbar fusion in 1998 to 0.48% of all patients undergoing lumbar fusion in 2011 (p<.001). The odds of experiencing a postoperative medical or surgical complication were not significantly different when comparing patients with IBD with control patients without IBD after controlling for patient demographics, comorbidity burden, and hospital characteristics (adjusted odds ratio=1.1, 95% confidence interval [CI] 0.99–1.3, p=.08). On multivariable analysis, the presence of IBD in patients undergoing lumbar fusion surgery was associated with longer length of stay and greater hospitalization charges.Conclusions
Among patients who underwent lumbar fusion, IBD is a rare comorbidity that is becoming increasingly more common. Importantly, patients with IBD were not at increased risk of postoperative complications. Spine surgeons should be prepared to treat more patients with IBD and should incorporate the present findings into preoperative risk counseling and patient selection. 相似文献20.
Joseph E. Tanenbaum Vincent J. Alentado Jacob A. Miller Daniel Lubelski Edward C. Benzel Thomas E. Mroz 《The spine journal》2017,17(3):338-345