Dede Ozgur, Thuillier Daniel, Pekmezci Murat, Ames Christopher P, Hu Serena S, Berven Sigurd H, Deviren Vedat
Department of Orthopedic Surgery, University of California San Francisco Spine Center, 500 Parnassus MU 320 W, San Francisco, CA 94143, USA.
Department of Neurological Surgery, University of California San Francisco Spine Center, 500 Parnassus MU 320 W, San Francisco, CA 94143, USA.
Spine J. 2015 May 1;15(5):977-82. doi: 10.1016/j.spinee.2013.05.039. Epub 2013 Jul 19.
Revision surgery for pseudarthrosis after a lumbar spinal fusion has unpredictable functional results.
The aim of this study was to determine the clinical outcomes of revision surgery to fuse the pseudarthrosis site based on the two most common diagnoses (degenerative disc disease [DDD] vs. spondylolisthesis).
Patients who had a revision surgery between 1995 and 2004 for lumbar pseudarthrosis after short segment lumbar spinal fusion were identified through the institution's Spine Center surgery database. A retrospective chart review of clinical, hospital, and anesthesia records was then performed.
Sixty-six patients were included in the study (28 patients with DDD and 38 patients with spondylolisthesis). Inclusion criteria were a surgical diagnosis of pseudarthrosis with a prior fusion of one or two motion segments, minimum 24 months of follow-up, and a diagnosis of either symptomatic DDD or spondylolisthesis as the primary indication for the index fusion surgery.
The Oswestry disability index (ODI) and a self-assessment questionnaire were used to evaluate clinical outcomes.
A retrospective chart and radiographic review was performed. Statistical analysis was done using Student t test for ODI scores and chi-square test for discrete variables from the outcome questionnaires.
Follow-up radiographs were available for 64 patients (97%), and a fusion rate of 100% was found in both groups for the radiographs examined. The mean postoperative ODI score was 53.3 (30-84.4) for DDD patients and 37.2 (2.5-76) for the spondylolisthesis group (p<.01). Only 50% of the patients in the DDD group felt that their overall well-being had improved since the surgery. In the spondylolisthesis group, 64% of patients stated that their overall well-being had improved since their revision surgery.
The clinical outcomes after revision surgery for pseudarthrosis are worse in patients with DDD compared with spondylolisthesis despite successful repair of nonunion. Risks and benefits should be well discussed with the patients before deciding on surgical treatment for the management of pseudarthrosis, especially in patients with previous short-segment fusions done for DDD.
腰椎融合术后假关节翻修手术的功能结果难以预测。
本研究旨在确定基于两种最常见诊断（退变性椎间盘疾病[DDD]与腰椎滑脱）对假关节部位进行融合的翻修手术的临床结果。
通过该机构的脊柱中心手术数据库，确定1995年至2004年间因短节段腰椎融合术后腰椎假关节而接受翻修手术的患者。然后对临床、医院和麻醉记录进行回顾性图表审查。
66例患者纳入研究（28例DDD患者和38例腰椎滑脱患者）。纳入标准为手术诊断为假关节，先前有一个或两个运动节段融合，至少随访24个月，以及诊断为有症状的DDD或腰椎滑脱作为初次融合手术的主要指征。
采用Oswestry功能障碍指数（ODI）和一份自我评估问卷来评估临床结果。
进行回顾性图表和影像学审查。使用学生t检验分析ODI评分，使用卡方检验分析结果问卷中的离散变量。
64例患者（97%）有随访X光片，两组接受检查的X光片融合率均为100%。DDD患者术后ODI平均评分为53.3（30 - 84.4），腰椎滑脱组为37.2（2.5 - 76）（p <.01）。DDD组仅50%的患者认为自手术以来其总体健康状况有所改善。在腰椎滑脱组，64%的患者表示自翻修手术以来其总体健康状况有所改善。
尽管假关节不愈合成功修复，但DDD患者假关节翻修手术后的临床结果比腰椎滑脱患者差。在决定对假关节进行手术治疗之前，应与患者充分讨论风险和益处，尤其是对于先前因DDD进行短节段融合的患者。
