Cheung Kenneth M C, Zhang Y G, Lu D S, Luk Keith D K, Leong John C Y
Department of Orthopaedic Surgery, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong.
Spine (Phila Pa 1976). 2003 Jul 1;28(13):1385-9. doi: 10.1097/01.BRS.0000067093.47584.CA.
A retrospective review with long-term clinical and radiologic assessment was conducted.
To assess the severity and reasons for the reduction of disc space distraction after successful autograft fusion of the lumbar spine and its clinical consequences.
Anterior lumbar interbody fusion is an established treatment for lumbar disc degeneration. It is not firmly established whether the grafted level narrows after surgery, and if so, what the clinical consequences are.
This study assessed 67 patients who underwent anterior lumbar interbody fusion at L4-L5 with autologous iliac crest graft. The disc space height and angle between L4 and L5 were serially measured. Times until fusion and the presence of symptoms before and after surgery and at the latest follow-up assessment were noted.
The mean follow-up period was 14 years (range, 2.5-32 years). The fusion rate was 96% (64 of 67 patients), and the mean time to fusion was 9 months. In the group that had successful fusion, there was an initial increase in disc space distraction followed by a reduction in 55 patients (86%). The mean preoperative disc space height was 12.1 mm, which increased immediately after surgery to 16.2 mm, but had been reduced to 12.6 mm at the latest follow-up assessment. The reduction in distraction occurred within the first 3 months after surgery and was correlated with age, but not with recurrence of symptoms, the amount of initial distraction, or the gender of the individual. A similar trend was seen with L4-L5 segmental angulation.
Reduction of disc space distraction after anterior lumbar interbody fusion using tricortical iliac crest bone graft is a common finding. Despite this, the fusion rate is high, and there is no association with symptom recurrence.
进行了一项具有长期临床和放射学评估的回顾性研究。
评估腰椎自体骨移植融合成功后椎间盘间隙撑开度减小的严重程度、原因及其临床后果。
腰椎前路椎间融合术是治疗腰椎间盘退变的一种既定方法。术后移植节段是否变窄，以及如果变窄其临床后果如何，目前尚无定论。
本研究评估了67例行L4-L5腰椎前路椎间融合术并采用自体髂嵴骨移植的患者。连续测量L4和L5之间的椎间盘间隙高度和角度。记录融合时间以及手术前后和最新随访评估时的症状情况。
平均随访期为14年（范围2.5 - 32年）。融合率为96%（67例患者中的64例），平均融合时间为9个月。在融合成功的组中，55例患者（86%）出现椎间盘间隙撑开度先增加后减小的情况。术前平均椎间盘间隙高度为12.1mm，术后立即增加到16.2mm，但在最新随访评估时已降至12.6mm。撑开度减小发生在术后前3个月内，且与年龄相关，但与症状复发、初始撑开量或个体性别无关。L4-L5节段成角情况也有类似趋势。
采用三皮质髂嵴骨移植的腰椎前路椎间融合术后椎间盘间隙撑开度减小是常见现象。尽管如此，融合率较高，且与症状复发无关。
