短节段独立侧方腰椎椎间融合术治疗退变性腰椎侧凸的再手术率及影像学结果

摘要(中文译文)

※ 中文译文由 AI 辅助生成,仅供学术参考,请以英文原文为准。

退行性腰椎侧凸（DLS）是老年人中的常见病症，患病率随年龄增长而增加。当保守治疗失败时，有多种手术治疗选择，从针对性减压融合到长节段畸形矫形手术。单纯侧方腰椎椎间融合术（SA-LLIF）可能是一种微创选择，用于处理顶椎水平的椎间盘源性疼痛和有症状的椎间孔狭窄；然而，关于其持久性和影像学结局的证据仍然有限。本研究评估了DLS患者接受1或2节段SA-LLIF后的翻修率、影像学结局及翻修手术的预测因素。我们回顾性分析了108例DLS患者，术前腰椎Cobb角≥20°，在单一学术中心接受1或2节段SA-LLIF。影像学参数在术前、术后首次X线片（FPO）及术后一年（1YPO）时进行评估。采用Kaplan-Meier法分析无翻修生存率，并使用多因素Cox回归评估翻修手术的预测因素。该队列平均年龄为67.0±11.9岁，56.5%为女性，平均随访时间为4.8±3.2年。25例患者（23.1%）在随访期间接受了翻修手术，其中9例（8.3%）在最初24个月内进行。在这些早期翻修中，最常见的适应证为邻近节段疾病（n=5，55.6%）和残余狭窄（n=4，44.4%）。年龄增长是翻修的唯一独立预测因素（HR 1.06/年，95% CI 1.01-1.11；p=0.013）。影像学方面，Cobb角从术前28.8°显著改善至FPO时的21.9°，并在1YPO时维持。LL轻度增加，而CVA和SVA基本保持不变。在接受短节段SA-LLIF的DLS患者中，早期翻修率较低，较长随访期的累积翻修率与后路融合手术所报道的相当。翻修风险主要与年龄相关，而非影像学参数。这些发现表明，SA-LLIF可能是经过仔细筛选的DLS患者的一种创伤较小的选择，可提供持续的冠状面矫正和LL的适度改善，而不会对整体脊柱平衡产生实质性改变。

Abstract

Degenerative lumbar scoliosis (DLS) is a common condition in older adults, with prevalence increasing with age. When conservative measures fail, there are many surgical treatment options, from targeted decompression and fusion to long construct deformity surgery. Standalone lateral lumbar interbody fusion (SA-LLIF) may be a minimally invasive option to address discogenic pain and symptomatic foraminal stenosis at the apex levels; however, evidence regarding durability and radiographic outcomes remains limited. This study evaluated revision rates, radiographic outcomes, and predictors of revision surgery following 1- or 2-level SA-LLIF in patients with DLS. We retrospectively reviewed 108 patients with DLS and a preoperative lumbar Cobb angle ≥ 20° who underwent 1- or 2-level SA-LLIF at a single academic center. Radiographic parameters were assessed preoperatively, at the first postoperative radiograph (FPO), and at one year postoperatively (1YPO). Revision-free survival was analyzed using Kaplan-Meier methods, and predictors of revision surgery were evaluated using multivariable Cox regression. The cohort had a mean age of 67.0 ± 11.9 years and 56.5% were female, with a mean follow-up of 4.8 ± 3.2 years. Twenty-five patients (23.1%) underwent revision surgery during follow-up, including 9 (8.3%) within the first 24 months. Among these early revisions, the most common indications were adjacent segment disease (n = 5, 55.6%) and residual stenosis (n = 4, 44.4%). Increasing age was the only independent predictor of revision (HR 1.06 per year, 95% CI 1.01-1.11; p = 0.013). Radiographically, Cobb angle improved significantly from 28.8° preoperatively to 21.9° at FPO and was maintained at 1YPO. LL increased modestly, while CVA and SVA remained largely unchanged. In patients with DLS undergoing short-segment SA-LLIF, early revision rates were low, and cumulative revision rates over longer follow-up were comparable to those reported for posterior fusion procedures. Revision risk was primarily associated with age rather than radiographic parameters. These findings suggest that SA-LLIF may represent a less invasive option in carefully selected patients with DLS, providing sustained coronal correction and modest improvement in LL, without substantial changes in overall spinal balance.

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