Masevnin Sergei, Ptashnikov Dmitry, Michaylov Dmitry, Meng Hao, Smekalenkov Oleg, Zaborovskii Nikita
Vreden Russian Research Institute of Traumatology and Orthopedics, Saint-Petersburg, Russia.
Asian Spine J. 2015 Apr;9(2):239-44. doi: 10.4184/asj.2015.9.2.239. Epub 2015 Apr 15.
Retrospective cohort study.
To identify factors which may be important in the occurrence of symptomatic adjacent segment disease (ASD) after lumbar fusion.
Many reports have been published about the risk factors for ASD after lumbar fusion. Despite on the great numbers of risk factors identified for ASD development, study results have been inconsistent and there is controversy regarding which are the most important.
This study evaluated 120 patients who underwent 360° fusion lumbar surgery from 2007 to 2012. We separated the population into two groups: the first group included 60 patients with long lumbar fusion (three or more levels) and the second group included 60 patients with short lumbar fusion (less than three levels).
In the first group, symptomatic ASD was found in 19 cases during the one year follow-up. There were 14 cases with sagittal imbalance and 5 cases at the incipient stage of disc degeneration according to the preoperative magnetic resonance imaging. At the three year follow-up, symptomatic ASD was diagnosed in 31 cases, of which 17 patients had postoperative sagittal balance disturbance. In the second group, 10 patients had ASD at the one year follow-up. Among these cases, preoperative disc degenerative changes were identified in 8 patients. Sagittal imbalance was found only in 2 cases with symptomatic ASD at the one year follow-up. At the three year follow-up, the number of patients with symptomatic ASD increased to 14. Among them, 13 patients had initial preoperative adjacent disc degenerative changes.
Patients with postoperative sagittal imbalance have a statistically significant increased risk of developing symptomatic ASD due to an overloading the adjacent segments and limited compensatory capacities due to the large number of fixed mobile segments. In the case of a short fixation, preoperative degenerative changes are more important factors in the development of ASD.
回顾性队列研究。
确定在腰椎融合术后发生症状性相邻节段疾病（ASD）中可能起重要作用的因素。
关于腰椎融合术后ASD的危险因素已有许多报道。尽管已确定了大量ASD发生的危险因素，但研究结果并不一致，对于哪些是最重要的危险因素仍存在争议。
本研究评估了2007年至2012年接受360°腰椎融合手术的120例患者。我们将患者分为两组：第一组包括60例长节段腰椎融合（三个或更多节段）患者，第二组包括60例短节段腰椎融合（少于三个节段）患者。
在第一组中，19例患者在一年随访期间出现症状性ASD。根据术前磁共振成像，有14例矢状面失衡，5例处于椎间盘退变初期。在三年随访时，31例患者被诊断为症状性ASD，其中17例患者术后矢状面平衡紊乱。在第二组中，10例患者在一年随访时出现ASD。在这些病例中，8例患者术前存在椎间盘退变改变。在一年随访时，仅2例有症状性ASD的患者出现矢状面失衡。在三年随访时，有症状性ASD的患者数量增加到14例。其中，13例患者术前存在相邻椎间盘退变改变。
术后矢状面失衡的患者发生症状性ASD的风险在统计学上显著增加，这是由于相邻节段负荷过重以及由于大量固定活动节段导致的代偿能力有限。在短节段固定的情况下，术前退变改变是ASD发生的更重要因素。
