Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 505 Banpo-Dong, Seocho-Ku, Seoul 137 040, Korea.
Eur Spine J. 2011 Nov;20(11):1951-60. doi: 10.1007/s00586-011-1917-0. Epub 2011 Jul 22.
To (1) clarify the role of various risk factors in the development of ASD, (2) compare instrumentation configuration with the development of ASD, (3) correlate the radiological incidence of ASD and its clinical outcome and (4) compare the clinical outcome between patients with radiological evidence of ASD and without ASD.
This study prospectively examined 74 consecutive patients who underwent instrumented lumbar/lumbosacral fusion for degenerative disease with a minimum follow-up of 5 years. Among the patients, 68 were enrolled in the study. All of the patients had undergone preoperative radiological assessment and postoperative radiological assessment at regular intervals. The onset and progression of ASD changes were evaluated. The patients were divided in two groups: patients with radiographic evidence of ASD (group 1) and patients without ASD changes (group 2). Comprehensive analysis of various risk factors between group 1 and group 2 patients was performed. The Visual Analog Scale (VAS) was used to evaluate the clinical outcome and the functional outcome was evaluated using the Oswestry Disability Index (ODI) before and after surgery along with radiological assessment.
Radiographic ASD occurred in 20.6% (14/68) of patients. Preoperative disc degeneration at an adjacent segment was a significant risk factor for ASD. Other risk factors such as the age of a patient at the time of surgery, gender, preoperative diagnosis, length of fusion, instrumentation configuration, sagittal alignment and lumbar or lumbosacral fusion were not significant risk factors for the development of ASD. There was no correlation between ASD and its clinical outcome as determined at the final follow-up session. In addition, clinical outcome of patients with ASD and without ASD were not comparable.
Patients with preoperative disc degeneration at an adjacent segment were more at risk for the development of ASD. Other risk factors including instrumentation configuration were not significantly associated with ASD. There was no correlation between both the radiological development of ASD and its clinical outcome and the clinical outcome of patients with and without ASD.
（1）阐明各种危险因素在 ASD 发展中的作用，（2）比较仪器配置与 ASD 的发展，（3）将 ASD 的放射发病率与其临床结果相关联，（4）比较有放射学证据的 ASD 患者与无 ASD 患者的临床结果。
本研究前瞻性检查了 74 例连续因退行性疾病接受器械性腰椎/腰骶融合术的患者，随访时间至少为 5 年。在这些患者中，有 68 例患者纳入本研究。所有患者均接受术前放射学评估和术后定期放射学评估。评估 ASD 变化的发生和进展。将患者分为两组：有放射学证据的 ASD 患者（组 1）和无 ASD 变化的患者（组 2）。对组 1 和组 2 患者的各种危险因素进行综合分析。使用视觉模拟评分（VAS）评估临床结果，使用 Oswestry 残疾指数（ODI）评估手术前后的功能结果以及放射学评估。
放射学 ASD 在 68 例患者中的 20.6%（14/68）中发生。术前相邻节段椎间盘退变是 ASD 的显著危险因素。其他危险因素，如手术时患者的年龄、性别、术前诊断、融合长度、仪器配置、矢状位对线以及腰椎或腰骶融合，均不是 ASD 发展的显著危险因素。在最终随访时，ASD 与其临床结果之间没有相关性。此外，ASD 患者与无 ASD 患者的临床结果无法比较。
术前相邻节段椎间盘退变的患者更有可能发生 ASD。其他危险因素，包括仪器配置，与 ASD 无显著相关性。ASD 的放射学发展及其与临床结果之间以及有 ASD 与无 ASD 患者的临床结果之间均无相关性。
