Kornblum Martin B, Fischgrund Jeffrey S, Herkowitz Harry N, Abraham David A, Berkower David L, Ditkoff Jeff S
Department of Orthopaedics, University of Virginia, Charlottesville, USA.
Spine (Phila Pa 1976). 2004 Apr 1;29(7):726-33; discussion 733-4. doi: 10.1097/01.brs.0000119398.22620.92.
A prospective, randomized study on patients who underwent posterior lumbar decompression with bilateral posterolateral arthrodesis.
To determine the long-term influence of pseudarthrosis on the clinical outcome of patients with degenerative spondylolisthesis and spinal stenosis.
Spinal decompression and posterolateral arthrodesis have been shown to be beneficial in the surgical treatment of symptomatic spinal stenosis with concurrent spondylolisthesis.
Forty-seven patients with single-level symptomatic spinal stenosis and spondylolisthesis were prospectively studied. Patients were treated with posterior decompression and bilateral posterolateral arthrodesis with autogenous bone graft. Radiographic evaluation was used to determine if fusion or pseudarthrosis was present. The solid fusion and pseudarthrosis groups were analyzed clinically, roentgenographically, and with a validated self-administered spinal stenosis questionnaire.
Forty-seven patients were available for review at a range of follow-up from 5 to 14 years. Average follow-up was 7 years 8 months. Clinical outcome was excellent to good in 86% of patients with a solid arthrodesis and in 56% of patients with a pseudarthrosis (P = 0.01). Significant differences in residual back and lower limb pain was discovered between the two groups using a scale ranging from 0 (no pain) to 5 (severe pain). Preoperative back and lower limb pain scores were statistically similar between the two groups. The solid fusion group performed significantly better in the symptom severity and physical function categories on the self-administered questionnaire. The two groups had similar results in the patient satisfaction category of this questionnaire.
In patients undergoing single-level decompression and posterolateral arthrodesis for spinal stenosis and concurrent spondylolisthesis, a solid fusion improves long-term clinical results. Benefits of a successful arthrodesis over pseudarthrosis were demonstrated with respect to back and lower limb symptomatology compared with prior shorter-term studies, which indicated no significant difference in clinical outcome between the two groups.
一项针对接受后路腰椎减压并双侧后外侧关节融合术患者的前瞻性随机研究。
确定假关节形成对退行性腰椎滑脱症和椎管狭窄症患者临床结局的长期影响。
脊柱减压和后外侧关节融合术已被证明对伴有腰椎滑脱症的症状性椎管狭窄症的手术治疗有益。
对47例单节段症状性椎管狭窄症和腰椎滑脱症患者进行前瞻性研究。患者接受后路减压和双侧后外侧关节融合术并使用自体骨移植。通过影像学评估确定是否存在融合或假关节形成。对坚固融合组和假关节形成组进行临床、影像学分析，并使用经过验证的椎管狭窄症患者自填问卷进行评估。
47例患者可供回顾，随访时间为5至14年。平均随访时间为7年8个月。坚固关节融合组86%的患者临床结局为优或良，假关节形成组为56%（P = 0.01）。两组之间在残余腰背部和下肢疼痛方面存在显著差异，疼痛程度采用0（无疼痛）至5（严重疼痛）的评分标准。两组术前腰背部和下肢疼痛评分在统计学上相似。在自填问卷的症状严重程度和身体功能类别方面，坚固融合组表现明显更好。在该问卷的患者满意度类别方面，两组结果相似。
对于接受单节段减压和后外侧关节融合术治疗椎管狭窄症并伴有腰椎滑脱症的患者，坚固融合可改善长期临床结果。与先前的短期研究相比，成功的关节融合术在腰背部和下肢症状方面优于假关节形成，先前的短期研究表明两组临床结局无显著差异。
