| Part 1 A long-term follow-up study of the effects of restoration of intervertebral height index on imaging parameters and degeneration of adjacent segments after single-level lumbar fusion with different fusion methodsPurposeTo compare the intervertebral height index and imaging parameters after single-level ALIF,TLIF or PLF,and to analyze the effect of restoration of intervertebral height index on radiographic degeneration of adjacent segments.MethodsA total of 504 patients underwent single-level L4-5 surgery in our department from March 2003 to October 2007,of which 221 met the inclusion and exclusion criteria of this study.According to the different surgical methods used on the 221 patients,they were divided into the ALIF group(27),TLIF group(136),and PLF group(58).Basal parameters(age,sex ratio,BMI,follow-up time,operation time,blood loss,and average hospital stay)were recorded for each group.Clinical outcome(Excellent,good,fair and poor)was assessed at the last follow-up.Pelvis incidence Angle(PI),pelvic inclination Angle(PT),sacral inclination Angle(SS),lumbar lordosis Angle(LL),segmental lordosis Angle(SL),lumbar 4-5 intervertebral height(IH),and lumbar 4-5 intervertebral height index(IHI)were measured.Incidence of radiographic adjacent segmental degeneration(rASD)were assessed at last follow-up.The changes of preoperative and postoperative imaging parameters in each group were compared.The previous research of our team recommends different reference values of the normal intervertebral height index for people of different ages and genders,so the patients of each group in this study were sub-divided into two parts: the restoration of intervertebral height index group and the non-restoration of intervertebral height index group.The effects of intervertebral height index on the above parameters were analyzed.ResultsAll the 221 patients were enrolled and followed up for a mean of 93 months(61-120 months).There were no significant differences in sex ratio,BMI,and follow-up time among the three groups(P > 0.05).The average age of the PLF group was higher than that of the ALIF group,and the blood loss and operation time of the TILF group were both higher than those of the ALIF group and PLF group,In terms of clinical efficacy,the excellent/good rates were similar in each group(84.5%,76.5%and 70.7%,respectively).with no statistical significance(P > 0.05).There were no significant differences in PI,PT,and SS among the three groups during the follow-up compared with preoperation(P > 0.05).LL,SL,IH,and IHI in the ALIF group and TLIF group were all increased compared with preoperation(P < 0.05),while there were no significant differences in the above indexes in the PLF group compared with preoperation(P >0.05).The proportions of mismatches of PI-LL,SL,IH,and IHI were statistically different among the three groups(P < 0.05).The LL,SL,IH,and IHI in TLIF and ALIF groups were higher than those in the PLF group,but the proportion of mismatch of PI-LL in the PLF group was higher than that in the other two groups.The rASD incidence in the PLF group was the highest(60.3%),while the lowest was in the ALIF group(29.6%),with the statistical difference between groups(P < 0.05).In the ALIF group,21 patients(77.7%)recovered the intervertebral height index,95 patients(69.9%)in the TLIF group,and 6 patients(10.3%)in the PLF group,and there was a statistical difference between the three groups(P < 0.05).In the ALIF group and TLIF group,LL and SL in the recovery sub-group were increased compared with those before surgery,with statistical significance(P < 0.05),while those in the non-recovery sub-group had no statistical difference compared with those before surgery(P > 0.05).In the PLF group,LL and SL in the recovery group were not significantly different from those before surgery(P > 0.05),while SL in the non-recovery group was significantly lower than that before surgery(P < 0.05).In the ALIF group,the proportion of PI-LL mismatch in the recovery group was significantly reduced(P < 0.05),while in the TLIF and PLF groups,the proportion of PI-LL mismatch in the recovery group and the non-recovery group were not statistically different from those before surgery(P > 0.05).Compared with the non-recovery group,SL in the recovery group was larger than that in the non-recovery group of the TLIF group,with statistical significance(P < 0.05).In the ALIF and TLIF groups,the proportion of PI-LL mismatch in the recovery group was less than that in the non-recovery group,which was statistically significant(P < 0.05).However,there was no statistically significant difference in the proportion of PI-LL mismatch between the two groups at each time point in the PLF group(P > 0.05).The incidence of rASD in the recovery group was lower than that in the non-recovery group of the three groups,with a statistical difference(P < 0.05).ConclusionALIF,TLIF and PLF have similar long-term clinical efficacy in the treatment of lumbar 4-5 single-level degenerative diseases.Among the three groups,the lowest incidence of ASD occurred in the ALIF group while the highest occurred in the PLF group,and the probability of PI-LL mismatch after PLF was higher.Restoring the intervertebral height index to the normal range in different surgical methods can better improve SL and LL,reduce the proportion of postoperative Pi-LL mismatches and reduce the occurrence of ASD.Part 2: Effects of restoration of intervertebral height index on imaging parameters and adjacent segment degeneration in single-segment TLIF of different levelsPurposeTo compare the intervertebral height index and imaging parameters after single-segment TLIF with different levels and to evaluate the effects of the restoration of intervertebral height index on radiographic degeneration of adjacent segmentsMethodsA total of 732 cases that underwent single-level lumbar TLIF surgery in our department from January 2010 to December 2014 were collected.According to the inclusion and exclusion criteria,a total of 304 patients were enrolled in the study and divided into L3-4 group,L4-5 group,and L5-S1 group according to the surgical segment.Basal parameters(age,sex ratio,BMI,follow-up time,operation time,blood loss,and average hospital stay)were recorded for each group.Clinical outcome(Excellent,good,fair and poor)was assessed at the last follow-up.PI,PT,SS,LL,SL,intervertebral height(IH)and intervertebral height index(IHI)were measured before and at the last follow-up.To assess the occurrence of rASD at the last follow-up,The changes of preoperative and postoperative imaging parameters and the incidence of rASD in each group were compared.According to the previous research results of our team: the reference range of lumbar spine normal adult intervertebral height index,patients in each group were further divided into recovery group,non-recovery group according to whether the intervertebral height index was restored to the normal range during the operation.The effect of recovered intervertebral height index on rASD was analyzed.ResultsThere were no statistical differences in sex ratio,BMI,and follow-up time among all groups(P > 0.05).There were significant differences in age,operation time,blood loss,and average hospital stay among all groups(P<0.05).The clinical outcomes were similar in each group at the last follow-up.The incidence of rASD in all groups was25.0%,32.2% and 29.4%,respectively,and there was no statistical difference among all groups(P > 0.05).During the last follow-up,there was no significant difference in SS and PI among all groups compared with preoperation(P > 0.05),while PT in L4-5 group decreased compared with preoperation,with a statistical difference(P < 0.05).IH and IHI in each group were increased at the follow-up compared with those before the operation,with a statistical difference(P < 0.05).LL and SL of L4-5 and L5-S1 groups were increased at follow-up compared with those before surgery,with a statistical difference(P < 0.05).There was no significant difference in LL and SL between the L3-4 group and the preoperative group during follow-up(P > 0.05).Intervertebral height index of 20 patients(70.7%)were recovered in the L3-4 group,123 cases(70.7%)in the L4-5 group,70 cases(66.0%)in the L5-S1 group.In the L4-5 group and L5-S1 group,there were statistically significant differences in the change value of LL,change the value of SL,the proportion of postoperative PI-LL mismatch,and incidence of rASD at follow-up between the recovery group and the non-recovery group(P < 0.05).The changes of LL and SL in the recovery group were greater,the proportion of postoperative PI-LL mismatch was smaller,and the incidence of rASD was lower.However,in the L3-4 group,there were no statistical differences between the recovery group and the non-recovery group in terms of the change value of SL,the proportion of postoperative PI-LL mismatch and the incidence of rASD at follow-up(P > 0.05),but there were only statistical differences between the recovery group and the non-recovery group in terms of the change value of LL(P < 0.05).ConclusionThere was no significant difference in the incidence of ASD after single-level TLIF.Restoration of the intervertebral height index of the surgical segment can reduce the occurrence of ASD after L4-5 and L5-S1 TLIF.Part 3: Effects of restoration of intervertebral height index on imaging parameters and adjacent segment degeneration in multi-level TLIFPurposeTo compare the intervertebral height index and imaging parameters after multi-level TLIF and to evaluate the effects of the restoration of intervertebral height index on radiographic degeneration of adjacent segments.MethodsA total of 113 cases of multi-level(≥ 2 level)LUMBAR TLIF surgery in our department from January 2010 to December 2019 were included in the study according to inclusion and exclusion criteria.According to the previous research results of our team: reference range of normal adult lumbar intervertebral height index,patients in each group were further divided into recovery group,non-recovery group and partially recovery group according to whether intervertebral height index was restored to normal range during operation.Basic parameters(age,sex ratio,BMI,follow-up time,operation time,blood loss,and mean hospital stay)were recorded.PI,PT,SS,LL,SL,intervertebral height(IH)and intervertebral height index(IHI)of surgical segment were measured before and at the last follow-up.The occurrence of rASD at the last follow-up was evaluated,and the changes of preoperative and postoperative imaging parameters in each group were compared.The influence of intervertebral height index on rASD was analyzed.In the multi-segmenta partial recovery group,combined with the upper and lower semicircle theory of lumbar curve and according to whether the upper and lower semicircle recovered intervertebral height index,the patients were divided into lower semicircle recovery group,lower semicircle non-recovery group,upper semicircle recovery group and upper semicircle non-recovery group.The incidence of rASD was compared between the two groups,and the effect of restoring the intervertebral height index of upper and lower semicircle on rASD was analyzed.ResultsAll cases were followed up for an average of 45 months(28-60 months).A total of 113 cases were collected,and the intervertebral height index was completely recovered in 42 cases,not recovered in 9 cases,and partially recovered in 62 cases,with a recovery rate of 37.2%.There were no statistically significant differences in age,sex ratio,BMI,follow-up time and average hospital stay among all groups(P >0.05).Compared with the non-recovery group,there were statistically significant differences in LL change value,SL change value,postoperative Pi-LL mismatching ratio and the incidence of rASD at follow-up between the recovery group and the partially recovered group(P < 0.05).In the recovery group,LL and SL changes were greater,the postoperative Pi-LL mismatching ratio was smaller,and the incidence of rASD was lower.There were 62 cases in the multi-segment partial recovery group,rASD occurred in 7 cases in the lower arc recovery group(24 cases),and 24 cases in the non-recovery group(38 cases),with a statistically significant difference(P=0.009).RASD occurred in 20 patients in the upper arc recovery group(46 cases),and 11 patients in the unrestored upper arc group(16 cases),showing no statistical difference between the groups(P=0.082).ConclusionWhen it comes to multi-level TLIF,the reduced occurrence of ASD and the proportion of postoperative PI-LL mismatch were only observed after restoring the intervertebral height index in the lower semicircle of the lumbar spine,unfortunately,no such results were found in the upper semicircle,which suggested that the recovery of the lower semicircular intervertebral height index based on the normal reference range plays an important role in the prevention of ASD in multi-level surgery. |
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