Li Chao, He Qing, Tang Yong, Ruan Dike
Department of Orthopaedics, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, People's Republic of China.
Department of Orthopaedics, Navy General Hospital, Beijing, 100048, People's Republic of China.
Eur Spine J. 2015 Nov;24(11):2468-73. doi: 10.1007/s00586-015-3921-2. Epub 2015 Apr 7.
To evaluate the impact of pre-existing disc degeneration and its extent on future adjacent segment degeneration (ASDeg) after lumbar posterolateral fusion (PLF).
A total of 102 patients who had undergone PLF for degenerative lumbar diseases from January 2006 to December 2008 were retrospectively reviewed by using radiography and clinical evaluation. The University of California at Los Angeles (UCLA) grading scale was used to evaluate the extent of disc degeneration. The Visual Analog Scale, Oswestry Disability Index, and SF-36 questionnaire were used to evaluate clinical outcomes.
The overall prevalence of radiological ASDeg was 25.5 %, and the prevalence of ASDeg for the cranial and caudal levels was 19.6 and 15.1 %, respectively. The prevalence of ASDeg in one-, two-, and three-level fusion was 15.8, 26.3, and 50 %, respectively (p = 0.008). For the cranial level, the preoperative UCLA grade A, B, and C groups had prevalence values for ASDeg of 13.5, 28.6, and 42.9 %, respectively (p = 0.026). A higher prevalence of ASDeg was found in cranial discs with pre-existing degeneration than in the group without pre-existing degeneration (p = 0.012). The group without pre-existing degeneration showed better outcomes. For the caudal level, there was no significant difference in ASDeg prevalence. At final follow-up, the group without pre-existing disc degeneration showed better outcomes than the group with pre-existing disc degeneration.
Adjacent segment discs with pre-existing degeneration had a higher likelihood of ASDeg progression compared with normal discs, especially for those classified as UCLA grade C.
评估腰椎后外侧融合术（PLF）前已存在的椎间盘退变及其程度对未来相邻节段退变（ASDeg）的影响。
回顾性分析2006年1月至2008年12月因退行性腰椎疾病接受PLF手术的102例患者，采用影像学检查和临床评估。使用加利福尼亚大学洛杉矶分校（UCLA）分级量表评估椎间盘退变程度。采用视觉模拟量表、Oswestry功能障碍指数和SF-36问卷评估临床结果。
影像学ASDeg的总体患病率为25.5%，上、下节段ASDeg的患病率分别为19.6%和15.1%。单节段、双节段和三节段融合患者的ASDeg患病率分别为15.8%、26.3%和50%（p = 0.008）。在上节段，术前UCLA A级、B级和C级组的ASDeg患病率分别为13.5%、28.6%和42.9%（p = 0.026）。已存在退变的上节段椎间盘ASDeg患病率高于无退变组（p = 0.012）。无退变组的临床结果更好。在下节段，ASDeg患病率无显著差异。在末次随访时，无椎间盘退变组的临床结果优于有椎间盘退变组。
与正常椎间盘相比，已存在退变的相邻节段椎间盘发生ASDeg进展的可能性更高，尤其是那些被分类为UCLA C级的椎间盘。
