Metal failure and nonunion at L5-S1 after long instrumented fusion distal to pelvis for adult spinal deformity: Anterior versus transforaminal interbody fusion

被引:8
作者
Park, Se-Jun [1 ]
Park, Jin-Sung [1 ]
Lee, Chong-Suh [1 ]
Lee, Keun-Ho [2 ]
机构
[1] Sungkyunkwan Univ, Samsung Med Ctr, Dept Orthoped Surg, Sch Med, Seoul, South Korea
[2] Hallym Univ, Kangdong Sacred Heart Hosp, Dept Orthoped Surg, Seoul, South Korea
关键词
Anterior lumbar interbody fusion; transforaminal lumbar interbody fusion; L5-S1; fusion; metal failure; long instrumented fusion; adult spinal deformity; SACROPELVIC FIXATION; BIOMECHANICAL ANALYSIS; LUMBOSACRAL-FIXATION; SAGITTAL ALIGNMENT; LUMBAR; S1; GALVESTON; SURGERY; SCREWS;
D O I
10.1177/23094990211054223
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Purpose Pseudoarthrosis and metal failure at L5-S1 following long fusion surgery for adult spinal deformity (ASD) remain major issues. Few studies report on which anterior column support technique is better in terms of achieving fusion and avoiding metal failures. Our study aimed to evaluate the fusion status and metal failure rate at L5-S1 after anterior lumbar interbody fusion (ALIF) versus transforaminal lumbar interbody fusion (TLIF). Methods The study population included patients aged >50 years who underwent surgery for ASD. Anterior column supports at L5-S1 using ALIF and TLIF were compared with >= 2-year follow-up. Fusion status on 2-year computed tomography (CT) scan, metal failure, visual analog scale (VAS), and Oswestry disability index (ODI) were evaluated. Results 98 patients were included in this study (53 ALIF group and 45 TLIF group). We achieved solid fusion on 2-year CT scans in 88.9% and 69.8% patients in the TLIF and ALIF group, respectively. Metal failure developed in nine (17.0%) and six (13.3%) patients in the ALIF and TLIF group, respectively. The most common failure type was unilateral L5-S1 rod fracture (7 and five patients in the ALIF and TLIF group, respectively). Only one patient with bilateral rod fractures in the ALIF group required revision surgery. There were no differences in the VAS and ODI scores at the last follow-up. Conclusions TLIF showed a better fusion rate than ALIF at L5-S1 after long instrumented fusion for ASD. However, the capacity to restore sagittal parameters was greater in the ALIF group. There were no differences between the groups regarding metal failure rate, revision surgery, or clinical outcomes.
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页数:11
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