Analysis Of Influencing Factors Of Nonunion After Posterior Lumbar Intervertebral Cage Fusion

Objective The purpose of this study is to analyze and discuss the influencing factors of nonunion of posterior lumbar interbody fusion,to provide more rational basis for clinical effective prevention and treatment for nonunion of posterior lumbar interbody fusion.Methods Through the electronic case system and imaging system,inquiries were made between February 2015 and December 2018 for patients with degenerative diseases of the lumbar spine who were admitted to the first spine trauma area of the First Affiliated Hospital of Jinan University for posterior intervertebral cage fusion.Through screening,a total of 294 cases,including 126 males and 168 females,with an average age of 56.40 ± 14.51 years.All patients were divided into two groups according to the Cage interbody fusion segment.The two groups are the fusion group and the non-fusion group.There were 31 cases in the posterior lumbar intervertebral Cage bone graft nonfusion group and 263 cases in the fusion group.Among them,there were 238 cases of single-segment lumbar intervertebral Cage bone graft group,219 cases of fusion group and 19 cases of non-fusion group.56 cases of lumbar intervertebral Cage bone grafting group with two fusion segments.By collecting general data and clinical data of two groups of patients.SPSS22.0 statistical software was used for data analysis of variable indicators.Continuous variables that conform to the normal distribution are tested by Independent-Samples t Test;ordered variables that do not conform to the normal distribution are tested by Kruskal-Wallis1-way ANOVA,a nonparametric independent sample,and categorical variables are tested by row × list(Chi-square Test).After testing,the statistically significant continuous variables were grouped and transformed,and then the relationship between each factor and intervertebral Cage bone graft nonunion was analyzed by a single factor Logistic regression model,and the variable of P <0.05 was selected for the multifactor Logistic regression model analysis.To discuss the risk factors associated with bone nonunion after fusion of lumbar intervertebral Cage bone graft.Results A total of 294 subjects were included,including 31 cases in the non-fusion group after intervertebral Cage graft fusion and 263 cases in the fusion group.The rate of nonfusion after intervertebral Cage graft fusion was 10.54%,126 cases in males and 168 cases in females,with a male to female ratio of 0.75:1,and the average age was 56.40 ± 14.51 years old.Intervertebral Cage bone graft fusion segment: 238 cases of singlesegment Cage bone grafting,accounting for 81%,and 56 cases of double-segment Cage bone grafting,accounting for 19%,of which 2 cases of L1/2 intervertebral Cage bone graft,2 cases of L2/3 intervertebral Cage bone graft,14 cases of L3/4 intervertebral Cage bone graft,150 cases of L4/5 intervertebral Cage bone graft,70 cases of L5/S1 intervertebral Cage bone graft,26 cases of L3/4 L4/5 intervertebral Cage bone graft,30 cases of L4/5 L5/S1 intervertebral cage bone graft.Univariate analysis showed that age,hypertension,diabetes,bone mineral density,albumin,fasting blood glucose,fusion segment,length of surgery,blood loss,and Cage size were closely related to the nonunion of posterior lumbar interbody Cage bone graft fusion,The difference was statistically significant(P<0.05).In terms of gender,height,weight,BMI,drinking history,smoking history,preoperative diagnosis,surgical method,spine-pelvic parameters,use of transverse rods,bone grafting materials,intervertebral Cage implant depth,there was no statistical significance(P>0.05)in the nonunion of posterior lumbar interbody Cage bone graft fusion.Single-segment intervertebral bone grafting grouping results showed that: in terms of age,intraoperative blood loss,fasting blood glucose,Cage size and bone density,the occurrence of nonunion of posterior lumbar interbody Cage bone graft fusion is closely related to the difference It is statistically significant(P<0.05).After adjusting for risk factors of age,hypertension,diabetes,operation time,blood loss,fasting blood glucose,single and double fusion segments,multivariate logistic regression analysis was performed.The osteoporosis group was compared with the normal bone group.The risk of nonunion of lumbar interbody fusion is increased by 3.335 times(95%CI: 1.77-6.27).The size 8 and size 10 Cage bone grafting groups had a 1.53 times(95%CI: 0.36-6.55)and 16.1 times(95%CI: 95% CI: 0.36-6.55)risk of bone fusion after surgery compared to the size 14 Cage bone grafting group.2.65-98.04).In the low albumin group,the risk of bone graft fusion was increased by 1.131 times(95%CI: 0.977-1.310).Conclusions 1.The risk factors of nonunion of posterior lumbar interbody Cage bone graft fusion are closely related to age,hypertension,diabetes,bone density,albumin,fasting blood glucose,fusion segment,operation time,blood loss,and Cage size.2.By regression equation analysis,after adjusting the risk factors of single and double fusion for age hypertensive diabetes,it was found that osteoporosis,low albumin and low Cage were independent risk factors for the nonunion of posterior lumbar interbody Cage bone graft fusion.3.The nonunion of posterior lumbar interbody Cage bone graft fusion is a result of multiple factors.The risk factors related to intervertebral cage bone graft fusion are taken seriously to reduce the incidence of intervertebral cage bone graft fusion.