腰椎后路椎间融合术后的相邻节段疾病：基于至少10年随访的病例
Adjacent Segment Disease After Posterior Lumbar Interbody Fusion: Based on Cases With a Minimum of 10 Years of Follow-up.
作者信息
Nakashima Hiroaki, Kawakami Noriaki, Tsuji Taichi, Ohara Tetsuya, Suzuki Yoshitaka, Saito Toshiki, Nohara Ayato, Tauchi Ryoji, Ohta Kyotaro, Hamajima Nobuyuki, Imagama Shiro
机构信息
*Meijo Hospital Orthopedics and Spine Center, 1-3-1 Sannomaru, Naka-ku, Nagoya 460-0001, Japan †Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi 466-8560, Japan; and ‡Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi 466-8560, Japan.
出版信息
Spine (Phila Pa 1976). 2015 Jul 15;40(14):E831-41. doi: 10.1097/BRS.0000000000000917.
STUDY DESIGN
Retrospective case-controlled study.
OBJECTIVE
To investigate the incidence of adjacent segment degeneration (ASD) and the associated risk factors during a period of at least 10 years after posterior lumbar interbody fusion (PLIF).
SUMMARY OF BACKGROUND DATA
ASD is a problematic sequelae after spinal fusion surgery. Few long-term follow-up studies have investigated ASD after PLIF; thus, magnetic resonance imaging (MRI) data available for the evaluation of postoperative changes associated with ASD are limited.
METHOD
One hundred one patients were retrospectively enrolled. The minimum follow-up was 10 years after surgery. Preoperative and postoperative (2, 5, and 10 yr after surgery) Radiographs and MRI images were evaluated. Disc height, vertebral slip, and intervertebral angle were examined on radiographical images. Disc degeneration and spinal stenosis on MRI images were evaluated. Risk factors for developing early-onset radiographical ASD were evaluated using a multivariate logistic regression analysis.
RESULT
The degenerative changes in disc height, vertebral slip, and intervertebral angle on radiographs 10 years after surgery were found in 12, 36, and 17 cases, respectively, at the cranial-adjacent level and in 3, 6, and 11 cases, respectively, at the caudal-adjacent level. Increased disc degeneration and spinal stenosis worsening were observed in 62 and 68 cases, respectively, at the cranial-adjacent level and in 25 and 12 cases, respectively, at the caudal-adjacent level on MRI 10 years after surgery. Ten patients (9.9%) required reoperation, and 80% of revision surgeries were performed more than 5 years after the initial surgery. High pelvic incidence was a risk factor for developing early-onset radiographical ASD.
CONCLUSION
The majority of the reoperations for ASD were performed more than 5 years after the initial lumbar fusion surgery, although the progression of radiographical ASD began in the early postoperative period. A high degree of pelvic incidence was a risk factor for developing early-onset radiographical ASD. Obtaining appropriate lumbar lordosis in PLIF is important for preventing ASD.
LEVEL OF EVIDENCE
研究设计
回顾性病例对照研究。
目的
调查腰椎后路椎间融合术（PLIF）后至少10年内相邻节段退变（ASD）的发生率及相关危险因素。
背景资料总结
ASD是脊柱融合手术后的一个棘手后遗症。很少有长期随访研究调查PLIF术后的ASD；因此，可用于评估与ASD相关的术后变化的磁共振成像（MRI）数据有限。
方法
回顾性纳入101例患者。术后最短随访时间为10年。评估术前及术后（术后2年、5年和10年）的X线片和MRI图像。在X线片上检查椎间盘高度、椎体滑脱和椎间角度。评估MRI图像上的椎间盘退变和椎管狭窄情况。采用多因素逻辑回归分析评估发生早期影像学ASD的危险因素。
结果
术后10年，在头侧相邻节段，分别有12例、36例和17例出现X线片上椎间盘高度、椎体滑脱和椎间角度的退变改变；在尾侧相邻节段，分别有3例、6例和11例出现上述改变。术后10年，在头侧相邻节段，MRI显示分别有62例和68例出现椎间盘退变加重和椎管狭窄加重；在尾侧相邻节段，分别有25例和12例出现上述改变。10例患者（9.9%）需要再次手术，80%的翻修手术在初次手术后5年以上进行。高骨盆发生率是发生早期影像学ASD的危险因素。
结论
尽管影像学ASD的进展始于术后早期，但大多数ASD翻修手术在初次腰椎融合手术后5年以上进行。高骨盆发生率是发生早期影像学ASD的危险因素。在PLIF中获得合适的腰椎前凸对预防ASD很重要。
证据等级
4级。
Zotero 插件