Yee Timothy J, Terman Samuel W, La Marca Frank, Park Paul
Department of Neurosurgery, University of Michigan, 1500 E. Medical Center Drive, Room 3552 TC, Ann Arbor, MI 48109-5338, USA.
Department of Neurosurgery, University of Michigan, 1500 E. Medical Center Drive, Room 3552 TC, Ann Arbor, MI 48109-5338, USA.
J Clin Neurosci. 2014 Oct;21(10):1796-801. doi: 10.1016/j.jocn.2014.03.010. Epub 2014 May 28.
Adjacent segment disease (ASD) is a potential long-term risk after lumbar fusion. Its incidence has been evaluated in anterior and posterior lumbar interbody fusions, but few studies have focused on transforaminal lumbar interbody fusion (TLIF). Relative risk of ASD with open or minimally invasive (MI) TLIF is poorly understood. To report our experience with risk for ASD in patients receiving TLIF and test its association with surgical approach, we performed a retrospective cohort study based on medical record review at a single institution. Eligible patients were ⩾ 18 years old at operation, underwent single-level TLIF during the period 2007-2008, and had at least 6 months postoperative follow-up. Patients were categorized by surgical approach (open versus MI). Primary outcome of interest was development of symptomatic ASD, defined by (1) new back and/or leg pain, (2) imaging findings adjacent to original surgical level, and (3) decision to treat. A total of 68 patients (16 open, 52 MI) were included in the analysis. Groups had similar baseline characteristics, except the open group tended to be older (p=0.04). Seven (10%) patients developed ASD. Mean patient age was 62 years and three were male. Three underwent open and four underwent MI TLIF. Risk of ASD did not differ significantly by surgical approach. The MI group showed a trend toward decreased risk of ASD compared to the open group, although it was not statistically significant. This suggests MI TLIF may be associated with decreased long-term morbidity compared to the open approach. Large prospective studies are needed to confirm these findings.
邻近节段病（ASD）是腰椎融合术后潜在的长期风险。其发生率已在前路和后路腰椎椎间融合术中进行了评估，但很少有研究关注经椎间孔腰椎椎间融合术（TLIF）。开放或微创（MI）TLIF术后发生ASD的相对风险尚不清楚。为了报告我们在接受TLIF患者中ASD风险的经验，并测试其与手术方式的关联，我们在单一机构基于病历回顾进行了一项回顾性队列研究。符合条件的患者手术时年龄≥18岁，在2007 - 2008年期间接受单节段TLIF，且术后至少随访6个月。患者按手术方式（开放与MI）分类。主要关注的结局是有症状ASD的发生，定义为：（1）新发腰背痛和/或腿痛；（2）原始手术节段相邻部位的影像学表现；（3）治疗决策。共有68例患者（16例开放手术，52例MI手术）纳入分析。两组基线特征相似，但开放手术组患者年龄往往较大（p = 0.04）。7例（10%）患者发生了ASD。患者平均年龄为62岁，3例为男性。3例接受开放手术，4例接受MI TLIF手术。ASD风险在手术方式上无显著差异。MI组与开放手术组相比，ASD风险有降低趋势，尽管无统计学意义。这表明与开放手术方式相比，MI TLIF可能与降低长期发病率相关。需要大型前瞻性研究来证实这些发现。
