Yu Chang Hun, Lee Jung Eun, Yang Jae Jun, Chang Bong-Soon, Lee Choon-Ki
Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea.
Asian Spine J. 2011 Jun;5(2):82-90. doi: 10.4184/asj.2011.5.2.82. Epub 2011 May 2.
A retrospective study.
To comparatively investigated the rate of the adjacent segment degeneration and the clinical outcomes in patients with spondylolytic spondylolisthesis, spinal stenosis or degenerative spondylolisthesis.
There have been few studies reported on the adjacent segment degeneration following posterior lumbar interbody fusion(PLIF). Many risk factors for the adjacent segment degeneration following PLIF have been proposed. The range of decompression has been presented as one of the risk factors, yet controversial.
This study enrolled sixty-three patients who had been treated with single-level PLIF and who were followed up for more than two years. The patients were divided into 3 groups based on the preoperative diagnosis. We analyzed the difference between the preoperative and postoperative intervertebral disc heights of the superior adjacent segments. The incidence rates of instability and the clinical outcomes were comparatively analyzed between each group.
The average age of the patients was 55.8 years in the spondylolytic spondylolisthesis group, 65.9 years in the degenerative spondylolisthesis group and 60.4 years in the spinal stenosis group. The average follow-up period was 44 months, 43 months and 42 months, respectively. At the last follow-up, compared to the preoperative period, the intervertebral disc height decreased in all three groups. A statistically significant decrease (p < 0.01) was observed only in the spondylolytic spondylolisthesis group and no significant difference was observed between each group (p = 0.41). The incidence rate of instability and the clinical outcome were not significantly different between each group.
Spondylolytic spondylolisthesis with total laminectomy and single-level PLIF showed no significant difference in the superior adjacent segment degeneration and instability, and the clinical outcome as compared to that of partial laminectomy with single-level PLIF for treating degenerative spondylolisthesis or spinal stenosis.
一项回顾性研究。
比较峡部裂性腰椎滑脱、腰椎管狭窄症或退变性腰椎滑脱患者相邻节段退变率及临床疗效。
关于后路腰椎椎间融合术（PLIF）后相邻节段退变的研究报道较少。已提出许多PLIF后相邻节段退变的危险因素。减压范围已被列为危险因素之一，但存在争议。
本研究纳入63例行单节段PLIF治疗且随访超过两年的患者。根据术前诊断将患者分为3组。分析上位相邻节段术前和术后椎间盘高度的差异。比较每组间不稳定发生率及临床疗效。
峡部裂性腰椎滑脱组患者平均年龄55.8岁，退变性腰椎滑脱组65.9岁，腰椎管狭窄组60.4岁。平均随访时间分别为44个月、43个月和42个月。末次随访时，与术前相比，三组椎间盘高度均降低。仅峡部裂性腰椎滑脱组观察到有统计学意义的降低（p<0.01），各组间无显著差异（p = 0.41）。每组间不稳定发生率及临床疗效无显著差异。
与单节段PLIF行部分椎板切除术治疗退变性腰椎滑脱或腰椎管狭窄症相比，单节段PLIF行全椎板切除术治疗峡部裂性腰椎滑脱在上位相邻节段退变、不稳定及临床疗效方面无显著差异。
