Prognosis of Symptomatic Pseudarthrosis Observed at 1 Year After Lateral Lumbar Interbody Fusion

被引:9
作者
Jung, Jong-Myung [1 ]
Chung, Chun Kee [2 ,3 ]
Kim, Chi Heon [2 ]
Yang, Seung Heon [2 ]
Ko, Young San [2 ]
机构
[1] Gachon Univ, Gil Med Ctr, Spine Ctr, Dept Neurosurg,Coll Med, Incheon, South Korea
[2] Seoul Natl Univ, Seoul Natl Univ Hosp, Dept Neurosurg, Coll Med, 101 Daehak Ro, Seoul 03080, South Korea
[3] Seoul Natl Univ, Dept Brain & Cognit Sci, Coll Nat Sci, Seoul, South Korea
关键词
diabetes; fusion level; lateral lumbar interbody fusion; pseudarthrosis; risk factor; smoking; FACET JOINT VIOLATION; TRANSPEDICULAR INSTRUMENTATION; COMPLICATIONS; ARTHRODESIS; PLIF;
D O I
10.1097/BRS.0000000000003980
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Study Design. Retrospective cohort study. Objective. The aim of this study was to investigate the prognosis of symptomatic pseudarthrosis observed at 1 year after lateral lumbar interbody fusion (LLIF) surgery and to analyze the risk factors for persistent pseudarthrosis for 2 years postoperatively. Summary of Background Data. Few articles have evaluated the prognosis of symptomatic pseudarthrosis following LLIF surgery. Methods. One hundred fifty-two patients with a minimum follow-up of 2 years were screened. Fusion status was assessed at 1 year postoperatively, and unfused segments were reevaluated at 2 years postoperatively. Dynamic x-rays and computed tomography images were acquired to evaluate the fusion status. Demographic data were evaluated to identify the risk factors associated with persistent pseudarthrosis. Clinical outcomes, including the visual analog scale (VAS) for back/leg pain and the Oswestry disability index (ODI), were evaluated preoperatively and at 1 and 2 years postoperatively. Results. Symptomatic pseudarthrosis was detected in 42 patients at 1 year postoperatively. Among them, 23 patients (54.8%) exhibited solid bony fusion 2 years postoperatively without further intervention. Fourteen patients (33.3%) showed asymptomatic pseudarthrosis, and the remaining five patients (11.9%) showed symptomatic pseudarthrosis. Multivariable analysis showed that diabetes (adjusted odds ratio [OR]: 2.817, P = 0.007), smoking (adjusted OR: 6.497, P = 0.008), and fusion at more than three levels (adjusted OR: 2.525, P = 0.031) were risk factors for persistent pseudarthrosis. Improvements in the VAS scores for back pain and ODI scores were significantly lower in the persistent pseudarthrosis group than in the final solid fusion group at 2 years postoperatively. Conclusion. It is not necessary to intervene for all patients in whom symptomatic pseudarthrosis is detected at 1 year postoperatively because only 11.9% of them will show persistent symptomatic pseudarthrosis. However, early revision surgery should be considered when severe symptomatic pseudarthrosis associated with diabetes, smoking, and fusion at more than three levels is present.
引用
收藏
页码:E1006 / E1013
页数:8
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