Dados do Trabalho
Título
Comparison Of Segmental Lordosis Gain of Prone Transpoas (PTP) Vs. Lateral Lumbar Interbody Fusion
Objetivo
Compare the segmental lordosis between LLIF and PTP
Metodologia
Retrospective, single centric, comparative, and non-randomized study. Patients receiving LLIF or PTP were paired to evaluate the technique's impact over the segmental lordosis correction. The following measures were taken: the index level segmental lordosis (SL), both preoperative and postoperative, Pelvic Incidence (PI), Pelvic Version (PT), Sacral Slope (SS), Lumbar Lordosis (LL), the delta segmental lordosis (postop SL – preop SL), and the cage position over the vertebral body (see definition below).
The cage position was defined by the location of the center of the cage concerning the vertebral body. Cage Position = Position of the Center of Cage /Vertebral Body Size.
All parameters, but the cage position component variables (that were measured at computerized tomography), were measured in the lateral profile X-ray. The patients were divided into two groups, PTP and LLIF. Then, a propensity-matched score analysis was to match the patients according to specific covariates. A stepwise linear regression model was performed to select which covariates to include in the PSM. The variables present in the final model were included in the propensity score model. The treatment effects will be assessed using a regression model with the relevant covariates and the matched data. Also, variance tests will be performed to assess the difference in segmental lordosis among the groups.To evaluate the normality of the sample, the authors used the Shapiro-Wilk test and performed the test for variances among the groups, the Wilcox test. The stepwise regression was done using the car package. The authors used the MatchIt package23 and the cobalt package24 to realize the balance analysis to perform the propensity score match. Also, the olsrr25(Braush-Pagan) and the nortest26(Shapiro-Francia) and car27(Variable inflation factor) packages were used to assess the adherence of the model to the linear regression presumption. Finally, the package jtools28 was used to extract the coefficient tables and effect plots. p-values equal or inferior to 0.05 were deemed as statistically significant.
Resultados
Sixty-eight patients were included in the analysis, fifty-three in the LLIF group and sixteen in the PTP group. The significant covariates to the segmental lordosis correction were Technique, Preoperative Segmental Lordosis, and Cage Position. In both PSM models, the PTP significantly correlated with the segmental lordosis correction incremental values varying from 4.01° to 4.54° compared to similar patients receiving LLIF.
Conclusões
The prone transpsoas approach can significantly enhance the correction of segmental lordosis proportionated by the traditional LLIF approach.
Área
Degenerativa lombar
Instituições
Instituto de Patologia da Coluna - São Paulo - Brasil
Autores
Rodrigo Amaral, Gabriel Pokorny, Rafael Moriguchi, Igor Barreira, Fernando Marcelino, Marcelo Yozo, Luiz Pimenta