Kim Yongjung J, Bridwell Keith H, Lenke Lawrence G, Rhim Seungchul, Kim Young-Woo
Washington University Medical Center, St. Louis, MO, USA.
Spine (Phila Pa 1976). 2007 Nov 15;32(24):2653-61. doi: 10.1097/BRS.0b013e31815a5a9d.
A retrospective comparison study.
To compare the postoperative proximal junctional change and revision prevalence as influenced by 3 different proximal levels after adult lumbar deformity instrumented fusion from the distal thoracic/upper lumbar spine (T9-L2) to L5 or S1.
Few comparative studies on postoperative sagittal plane change and revision prevalence as influenced by 3 different proximal levels after adult lumbar deformity instrumented fusion from the distal thoracic/upper lumbar spine (T9-L2) to L5 or S1 have been published. Many surgeons have hypothesized that stopping proximally in the upper lumbar spine (L1 or L2) or the thoracolumbar junction (T11 or T12) would lead to a high percentage of rapid proximal degeneration, kyphosis, and decompensation because of the concentration of stress on these relatively mobile segments. Therein, many surgeons have felt it is unsafe to stop at these regions of the spine and it is better to always stop proximally at T9 or T10.
A clinical and radiographic assessment in addition to revision prevalence of 125 adult lumbar deformity patients (average age 57.1 year) who underwent long (average 7.1 vertebrae) segmental posterior spinal instrumented fusion from the distal thoracic/upper lumbar spine (T9-L2) to L5 or S1 with a minimum 2-year follow-up (2-19.8 year follow-up) were compared as influenced by T9-T10 (group 1, n = 37), T11-T12 (group 2, n = 49), and L1-L2 (group 3, n = 39) proximal fusion levels. The revision prevalence and sagittal Cobb angle change at the proximal junction after surgery were compared.
Three groups demonstrated nonsignificant differences in the prevalence of proximal junctional kyphosis (group 1 51% vs. group 2 55% vs. group 3 36%, P = 0.20) and revision (group 1 24% vs. group 2 24% vs. group 3 26%, P = 0.99) at the ultimate follow-up. Subsequent proximal junctional angle and sagittal vertical axis changes between the ultimate follow-up and preoperative (P = 0.10 and 0.46 respectively) were not significantly different. The SRS total and all subscale outcomes scores among the 3 groups did not demonstrate significant differences (P > 0.50).
Three different proximal fusion levels did not demonstrate significant radiographic and clinical outcomes or revision prevalence after surgery. Therefore the more distal proximal fusion level at a neutral and stable vertebra may be satisfactory.
一项回顾性对比研究。
比较成人腰椎畸形从胸段远端/上腰椎（T9-L2）至L5或S1进行器械融合术后，3个不同近端水平对近端交界区变化及翻修率的影响。
关于成人腰椎畸形从胸段远端/上腰椎（T9-L2）至L5或S1进行器械融合术后，3个不同近端水平对矢状面变化及翻修率影响的比较研究鲜有发表。许多外科医生推测，在上腰椎（L1或L2）或胸腰段交界区（T11或T12）近端终止融合，会因应力集中在这些相对活动的节段，导致较高比例的近端快速退变、后凸畸形和失代偿。因此，许多外科医生认为在脊柱的这些区域终止融合不安全，最好总是在T9或T10近端终止融合。
对125例成人腰椎畸形患者（平均年龄57.1岁）进行临床和影像学评估，并比较翻修率。这些患者接受了从胸段远端/上腰椎（T9-L2）至L5或S1的长节段（平均7.1个椎体）后路脊柱器械融合术，且至少随访2年（随访时间为2 - 19.8年），比较T9-T10（第1组，n = 37）、T11-T12（第2组，n = 49）和L1-L2（第3组，n = 39）近端融合水平对其的影响。比较术后近端交界区的翻修率和矢状面Cobb角变化。
在末次随访时，三组在近端交界区后凸畸形发生率（第1组51% vs. 第2组55% vs. 第3组36%，P = 0.20）和翻修率（第1组24% vs. 第2组24% vs. 第3组26%，P = 0.99）方面无显著差异。末次随访与术前相比，随后的近端交界区角度和矢状垂直轴变化（分别为P = 0.10和0.46）无显著差异。三组间SRS总分及所有子量表结果评分无显著差异（P > 0.50）。
3个不同的近端融合水平在术后的影像学和临床结果或翻修率方面无显著差异。因此，在中立且稳定的椎体处选择更靠下的近端融合水平可能是令人满意的。
