Department of Orthopedic Surgery, Nagoya University School of Medicine, Japan.
Spine (Phila Pa 1976). 2009 Dec 1;34(25):2775-81. doi: 10.1097/BRS.0b013e3181b4b1c2.
A retrospective, comparative study.
To assess the effects of soft stabilization with artificial ligamentous bands placed on the upper segment adjacent to posterior lumbar interbody fusion (PLIF) for prevention of transition syndrome compared with patients who underwent PLIF without soft stabilization.
Spine fusion increases mechanical stress and can cause other spinal problems adjacent to the fusion level. Soft stabilization using artificial ligamentous bands has been reported to decrease the flexion instability and this iatrogenic problems. There is no report concerning the effect of soft stabilization to transition syndrome following PLIF.
In 225 patients undergoing L4/5 PLIF, 70 consecutive patients who were treated concomitantly with decompression of L3/4 with minimum 2-year follow-up were included. Thirty-five patients underwent soft stabilization of L3/4 (soft stabilization [S] group) with natural neutral concept rods, and 35 patients did not (decompression [D] group). Radiographic changes in the disc height, vertebral slip, intervertebral angle, range of motion, lumbar lordosis, and L3 tilt angle were measured. On magnetic resonance imaging (MRI), postoperative progression of the disc degeneration and spinal canal stenosis were evaluated. RESULTS.: In the S group, significant posterior intervertebral expansion on radiograph was less advanced at the final follow-up (P < 0.005). MRI images demonstrated less significant aggravation of disc degeneration (P < 0.001) and progression of adjacent stenosis (P < 0.01), at L3/4 in the S group. Adjacent intervertebral changes on MRI occurred relatively early after surgery, suggesting that changes were due to transition syndrome, but not age-related changes.
These results demonstrated an effect of soft stabilization for the prevention of transition syndrome in lumbar spine fusion. Although the postoperative follow-up periods in this study were not sufficiently long to reach a definitive conclusion, intervertebral breakdown adjacent to the rigid spine fusion could be diminished by the application of soft stabilization.
回顾性对比研究。
评估在上腰椎节段相邻部位放置人工韧带软固定对预防后路腰椎体间融合（PLIF）术后过渡综合征的效果，与未行软固定的 PLIF 患者进行比较。
脊柱融合会增加机械应力，并可能导致融合水平相邻的其他脊柱问题。已有报道称，使用人工韧带软固定可减少融合术后的屈伸不稳定和医源性问题。但目前尚无关于 PLIF 术后软固定对过渡综合征影响的报道。
在 225 例接受 L4/5PLIF 的患者中，选择同时接受 L3/4 减压治疗且至少随访 2 年的 70 例连续患者。35 例患者接受 L3/4 软固定（软固定[S]组），采用天然中性概念棒，35 例患者未行软固定（减压[D]组）。测量椎间盘高度、椎体滑移、椎间角、活动范围、腰椎前凸和 L3 倾斜角的影像学变化。通过磁共振成像（MRI）评估术后椎间盘退变和椎管狭窄的进展。
在 S 组中，在最终随访时，影像学上的后位椎间扩张程度进展较慢（P < 0.005）。MRI 图像显示 S 组 L3/4 节段椎间盘退变加重程度较轻（P < 0.001），相邻狭窄进展程度较轻（P < 0.01）。MRI 上的相邻椎间变化在术后相对较早发生，提示这些变化是由于过渡综合征，而不是与年龄相关的变化。
这些结果表明软固定对预防腰椎融合术后过渡综合征有一定效果。尽管本研究的术后随访时间不够长，无法得出明确结论，但通过应用软固定，可能会减少刚性脊柱融合部位相邻的椎间破坏。
