Min Jun-Hong, Jang Jee-Soo, Jung Byung joo, Lee Ho Yeon, Choi Won-Chul, Shim Chan Shik, Choi Gun, Lee Sang-Ho
Department of Neurosurgery, Gimpo Airport Wooridul Spine Hospital, Seoul, Korea.
J Spinal Disord Tech. 2008 Jul;21(5):305-9. doi: 10.1097/BSD.0b013e318142b960.
A retrospective study.
The aims of this study were to evaluate the clinical significance of, characteristics of, and risk factors for adjacent segment degeneration (ASD) in patients who have undergone instrumented lumbar fusion.
ASD has been considered a potential long-term complication of spinal arthrodesis. However, the exact mechanisms and risk factors related to ASD are not completely understood.
A total of 48 patients who underwent instrumented lumbar fusion at L4-5 and had minimal ASD preoperatively were evaluated. The patients were divided into 2 groups at follow-up according to the development of ASD defined by radiologic criteria. Through review of their medical records and the radiologic files, the following variables were evaluated in the 2 groups: basic demographic data, body weight, body height, body mass index, bone mineral density, types of surgical approaches, preoperative and postoperative segmental and lumbar lordosis, and clinical outcomes.
ASD was found in 30 (62.5%) patients. The variables that showed statistical intergroup differences were the mean age at surgery, the mean difference in the degree of preoperative from postoperative lumbar lordosis, and the proportion of patients who underwent anterior lumbar interbody fusion. However, there were no statistically significant intergroup differences in the Japanese Orthopedic Association score at 1-year postoperatively or at the final follow-up, or in the recovery rate, success rate, and complication rate.
Radiographic ASD is relatively common long-term finding associated with instrumented lumbar fusion. However, radiographic evidence of ASD does not necessarily correlate with a poor outcome. Our results suggest that advanced age, anterior lumbar interbody fusion, and the restoration of the preoperative standing lumbar lordosis may have a protective effect against the development of ASD.
一项回顾性研究。
本研究旨在评估接受腰椎融合内固定术患者相邻节段退变（ASD）的临床意义、特征及危险因素。
ASD被认为是脊柱融合术的一种潜在长期并发症。然而，与ASD相关的确切机制和危险因素尚未完全明确。
对48例在L4 - 5节段接受腰椎融合内固定术且术前ASD程度轻微的患者进行评估。随访时根据放射学标准定义的ASD发生情况将患者分为两组。通过查阅他们的病历和放射学档案，对两组患者评估以下变量：基本人口统计学数据、体重、身高、体重指数、骨密度、手术入路类型、术前和术后节段性及腰椎前凸，以及临床结局。
30例（62.5%）患者出现ASD。组间有统计学差异的变量为手术时的平均年龄、术前与术后腰椎前凸度数的平均差值，以及接受腰椎前路椎间融合术的患者比例。然而，术后1年及末次随访时日本骨科协会评分、恢复率、成功率及并发症发生率在组间无统计学显著差异。
影像学上的ASD是与腰椎融合内固定术相关的相对常见的长期表现。然而，ASD的影像学证据不一定与不良结局相关。我们的结果表明，高龄、腰椎前路椎间融合术以及术前站立位腰椎前凸的恢复可能对ASD的发生有保护作用。
