Eck K R, Bridwell K H, Ungacta F F, Riew K D, Lapp M A, Lenke L G, Baldus C, Blanke K
Department of Orthopaedic Surgery, Barnes-Jewish Hospital at Washington University, St. Louis, Missouri 63110, USA.
Spine (Phila Pa 1976). 2001 May 1;26(9):E182-92. doi: 10.1097/00007632-200105010-00012.
This is a consecutive study of patients having undergone surgical treatment of adult lumbar scoliosis. Follow-up ranged from 2 to 13 years (average 5 years).
To assess the complications and outcomes of patients with long fusions to L4 (n=23), L5 (n=21), or the sacrum (n=15) and determine if a "deeply seated" L5 segment is protective.
Few studies assess outcomes and complications in adults fused from the thoracic spine to L4, L5, or the sacrum with minimum 2-year follow-up.
Fifty-eight patients (59 cases; average age 43 years; range 21 to 60) with minimum 2-year follow-up were analyzed for subsequent spinal degeneration and complications. Outcomes were assessed from questionnaires administered at latest follow-up.
Sixteen percent of cases (7 of 44) fused short of the sacrum displayed subsequent postoperative distal spinal degeneration, although only three patients were symptomatic. Compared with the group with no subsequent degeneration, this group had a lower improvement in function and pain relief. Other complications for patients fused short of the sacrum included two cases with crosslink breakage, one with neurologic deficit, three with pseudarthroses, one with hook pullout, and one with L5 screw pullout. For cases fused to the sacrum, two cases with deep wound infections and one with loose iliac screw requiring removal were observed. Because two of four cases fused to L5 with subsequent degeneration at L5-S1 were observed to have "deeply seated" L5 segments and two of the four did not, the authors could conclude only that "deep seating" of L5 is not absolute protection.
Fusions short of the sacrum did not have predictable long-term results. Those fused short of the sacrum who developed distal spinal degeneration had worse outcomes. Patients fused to the sacrum did not have a higher complication rate. A "deeply seated" L5 segment does not necessarily protect the L5-S1 disc.
这是一项对接受成人腰椎侧弯手术治疗患者的连续研究。随访时间为2至13年（平均5年）。
评估融合至L4（n = 23）、L5（n = 21）或骶骨（n = 15）的长节段融合患者的并发症及预后，并确定“低位”L5节段是否具有保护作用。
很少有研究评估从胸椎融合至L4、L5或骶骨且随访至少2年的成人患者的预后及并发症。
对58例患者（59例；平均年龄43岁；范围21至60岁）进行了至少2年的随访分析，以观察其随后的脊柱退变及并发症情况。通过在最近一次随访时发放的问卷评估预后。
融合至骶骨以下的病例中有16%（44例中的7例）出现了术后远端脊柱退变，不过只有3例患者有症状。与无后续退变的组相比，该组在功能改善和疼痛缓解方面较差。融合至骶骨以下患者的其他并发症包括2例连接棒断裂、1例神经功能缺损、3例假关节形成、1例钩钉拔出和1例L5螺钉拔出。对于融合至骶骨的病例，观察到2例深部伤口感染和1例需要取出的髂骨螺钉松动。由于融合至L5且随后L5 - S1出现退变的4例病例中有2例观察到有“低位”L5节段，另外2例没有，作者只能得出结论，L5的“低位”并非绝对的保护因素。
融合至骶骨以下的手术没有可预测的长期结果。那些融合至骶骨以下且发生远端脊柱退变的患者预后较差。融合至骶骨的患者并发症发生率并没有更高。“低位”L5节段不一定能保护L5 - S1椎间盘。
