Predictive value of vertebral CT parameters for early fusion sink after TLIF

doi:10.11958/20241833

Abstract

Abstract:

Objective To investigate the prognostic value of vertebral CT parameters for early fusion sink after transforaminal lumbar interbody fusion (TLIF). Methods The clinical and imaging data of 178 patients with lumbar degenerative diseases treated by TLIF were retrospectively studied. The patients were divided into the sedimentation group (n=57) and the non-sedimentation (n=57) group according to the patient's fusion device settlement 3 months after surgery. The results of general data and CT image parameters were compared between the two groups. Multivariate Logistic regression was used to analyze risk factors of early fusion subsidence, and the prediction efficiency was analyzed. Results The incidence of the early fusion sink was 32.0%. Compared with the non-sedimentation group, the sedimentation group had a higher proportion of patients aged ≥60 years, osteoporosis, L5-S1 and intervertebral space height, larger fusion contact area and segmental lordosis angle and lower lumbar CT value (P<0.05). Logistic regression analysis showed that age ≥60 years old, surgical level L₅-S₁, high intervertebral height and large segmental lordosis angle were independent risk factors for the early fusion after TLIF, while high lumbar CT value was protective factor (P<0.05). Subject working characteristic curves showed that the area under the curve (AUC) of lumbar CT value, intervertebral height, segmental lordosis angle combined with AUC were higher than those of patients aged ≥60 years, surgical segment L₅-S₁, lumbar CT value, intervertebral height, segmental lordosis angle applied alone (P<0.05). Conclusion Vertebral CT parameters of lumbar CT value, intervertebral height and segmental lordosis angle have higher predictive value for the early fusion after TLIF, and the combined prediction value of the three parameters is higher.

Key words: intervertebral disc degeneration, vertebral body, tomography, X-ray computed, transforaminal lumbar interbody fusion, cage subsidence

CLC Number:

R681.5

Figures/Tables 7

References 23

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组别			n		年龄								性别						BMI/（kg/m²）			病程/月
组别			n		<60岁				≥60岁				男			女			BMI/（kg/m²）			病程/月
无沉降组			121		65（53.72）				56（46.28）				60（49.59）			61（50.41）			23.87±2.13			45.76±8.34
沉降组			57		20（35.09）				37（64.91）				23（40.35）			34（59.65）			24.01±2.08			46.84±8.14
χ²或t					5.391^＊								1.328						0.412			0.814
组别		合并症															疾病类型
组别		高血压					糖尿病			高脂血症				骨质疏松症			腰椎间盘突出症				腰椎滑脱		腰椎管狭窄
无沉降组		29（23.97）					27（22.31）			24（19.83）				30（24.79）			34（28.10）				41（33.88）		46（38.02）
沉降组		15（26.32）					14（24.56）			13（22.81）				24（42.11）			23（40.35）				15（26.32）		19（33.33）
χ²		0.115				0.110				0.208				5.495^＊			2.754
组别	手术节段											融合器长度/mm			融合器高度/mm			融合器接触面积/%		手术时间/min			术中出血量/mL
组别	L_2—3			L_3—4				L_4—5			L₅—S₁	融合器长度/mm			融合器高度/mm			融合器接触面积/%		手术时间/min			术中出血量/mL
无沉降组	26（21.49）			25（20.66）				20（16.53）			50（41.32）	8.99±1.21			10.64±2.12			34.5±2.3		175.34±34.38			121.35±35.85
沉降组	2（3.51）			4（7.02）				16（28.07）			35（61.40）	9.35±1.18			11.21±2.24			35.6±2.4		181.58±34.30			131.23±45.34
χ²或t	18.213^＊＊											1.871			1.670			2.787^＊＊		1.131			1.572

组别			n		年龄								性别						BMI/（kg/m²）			病程/月
组别			n		<60岁				≥60岁				男			女			BMI/（kg/m²）			病程/月
无沉降组			121		65（53.72）				56（46.28）				60（49.59）			61（50.41）			23.87±2.13			45.76±8.34
沉降组			57		20（35.09）				37（64.91）				23（40.35）			34（59.65）			24.01±2.08			46.84±8.14
χ²或t					5.391^＊								1.328						0.412			0.814
组别		合并症															疾病类型
组别		高血压					糖尿病			高脂血症				骨质疏松症			腰椎间盘突出症				腰椎滑脱		腰椎管狭窄
无沉降组		29（23.97）					27（22.31）			24（19.83）				30（24.79）			34（28.10）				41（33.88）		46（38.02）
沉降组		15（26.32）					14（24.56）			13（22.81）				24（42.11）			23（40.35）				15（26.32）		19（33.33）
χ²		0.115				0.110				0.208				5.495^＊			2.754
组别	手术节段											融合器长度/mm			融合器高度/mm			融合器接触面积/%		手术时间/min			术中出血量/mL
组别	L_2—3			L_3—4				L_4—5			L₅—S₁	融合器长度/mm			融合器高度/mm			融合器接触面积/%		手术时间/min			术中出血量/mL
无沉降组	26（21.49）			25（20.66）				20（16.53）			50（41.32）	8.99±1.21			10.64±2.12			34.5±2.3		175.34±34.38			121.35±35.85
沉降组	2（3.51）			4（7.02）				16（28.07）			35（61.40）	9.35±1.18			11.21±2.24			35.6±2.4		181.58±34.30			131.23±45.34
χ²或t	18.213^＊＊											1.871			1.670			2.787^＊＊		1.131			1.572

组别	n	腰椎CT 值/HU	椎间隙高度/mm	节段性前凸角/°	腰椎前凸角/°	骨盆入射角/°	骨盆倾斜角/°	螺钉内倾角/°	螺钉尾倾角/°
无沉降组	121	131.03±11.19	12.30±1.24	17.99±1.87	45.28±13.59	49.14±9.32	32.85±4.99	13.49±2.87	11.85±3.67
沉降组	57	110.80±10.92	13.57±1.15	20.45±1.95	47.25±12.24	48.70±8.24	31.68±5.26	13.12±2.98	11.25±3.87
t		11.337^＊＊	6.562^＊＊	8.070^＊＊	0.936	0.298	1.423	0.771	0.982

组别	n	腰椎CT 值/HU	椎间隙高度/mm	节段性前凸角/°	腰椎前凸角/°	骨盆入射角/°	骨盆倾斜角/°	螺钉内倾角/°	螺钉尾倾角/°
无沉降组	121	131.03±11.19	12.30±1.24	17.99±1.87	45.28±13.59	49.14±9.32	32.85±4.99	13.49±2.87	11.85±3.67
沉降组	57	110.80±10.92	13.57±1.15	20.45±1.95	47.25±12.24	48.70±8.24	31.68±5.26	13.12±2.98	11.25±3.87
t		11.337^＊＊	6.562^＊＊	8.070^＊＊	0.936	0.298	1.423	0.771	0.982

变量	β	SE	Wald χ²	P	OR	95%CI
年龄	0.536	0.197	7.403	0.026	1.709	1.162~2.515
手术节段	0.641	0.215	8.889	0.012	1.898	1.246~2.893
椎间隙高度	0.685	0.203	11.386	<0.001	1.984	1.333~2.953
节段性前凸角	0.988	0.312	10.028	<0.001	2.686	1.457~4.951
腰椎CT值	-0.789	0.192	16.887	<0.001	0.454	0.312~0.662
常数项	-0.421	0.184	5.235	0.045	-	-