Zhong Zhao-Ming, Deviren Vedat, Tay Bobby, Burch Shane, Berven Sigurd H
Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, China.
Department of Orthopaedic Surgery, University of California, San Francisco, CA, USA.
Clin Neurol Neurosurg. 2017 May;156:29-34. doi: 10.1016/j.clineuro.2017.02.020. Epub 2017 Feb 27.
A potential long-term complication of lumbar fusion is the development of adjacent segment disease (ASD), which may necessitate second surgery and adversely affect outcomes. The objective of this is to determine the incidence of ASD following instrumented fusion in adult patients with lumbar spondylolisthesis and to identify the risk factors for this complication.
We retrospectively assessed adult patients who had undergone decompression and instrumented fusion for lumbar spondylolisthesis between January 2006 and December 2012. The incidence of ASD was analyzed. Potential risk factors included the patient-related factors, surgery-related factors, and radiographic variables such as sagittal alignment, preexisting disc degeneration and spinal stenosis at the adjacent segment.
A total of 154 patients (mean age, 58.4 years) were included. Mean duration of follow-up was 28.6 months. Eighteen patients (11.7%) underwent a reoperation for ASD; 15 patients had reoperation at cranial ASD and 3 at caudal ASD. The simultaneous decompression at adjacent segment (p=0.002) and preexisting spinal stenosis at cranial adjacent segment (p=0.01) were identified as risk factors for ASD. The occurrence of ASD was not affected by patient-related factors, the types, grades and levels of spondylolisthesis, surgical approach, fusion procedures, levels of fusion, number of levels fused, types of bone graft, use of bone morphogenetic proteins, sagittal alignment, preexisting adjacent disc degeneration and preexisting spinal stenosis at caudal adjacent segments.
Our findings suggest the overall incidence of ASD is 11.7% in adult patients with lumbar spondylolisthesis after decompression and instrumented fusion at a mean follow-up of 28.6 months, the simultaneous decompression at the adjacent segment and preexisting spinal stenosis at cranial adjacent segment are risk factors for ASD.
腰椎融合术的一个潜在长期并发症是相邻节段疾病（ASD）的发生，这可能需要二次手术并对治疗结果产生不利影响。本研究的目的是确定成年腰椎滑脱症患者行器械辅助融合术后ASD的发生率，并确定该并发症的危险因素。
我们回顾性评估了2006年1月至2012年12月期间因腰椎滑脱症接受减压和器械辅助融合术的成年患者。分析了ASD的发生率。潜在危险因素包括患者相关因素、手术相关因素以及影像学变量，如矢状位排列、相邻节段既往存在的椎间盘退变和椎管狭窄。
共纳入154例患者（平均年龄58.4岁）。平均随访时间为28.6个月。18例患者（11.7%）因ASD接受了再次手术；15例患者在颅侧ASD处接受了再次手术，3例在尾侧ASD处接受了再次手术。相邻节段同时减压（p=0.002）和颅侧相邻节段既往存在的椎管狭窄（p=0.01）被确定为ASD的危险因素。ASD的发生不受患者相关因素、腰椎滑脱的类型、分级和节段、手术入路、融合手术、融合节段、融合节段数、骨移植类型、骨形态发生蛋白的使用、矢状位排列、既往相邻椎间盘退变以及尾侧相邻节段既往存在的椎管狭窄的影响。
我们的研究结果表明，成年腰椎滑脱症患者在减压和器械辅助融合术后，平均随访28.6个月时，ASD的总体发生率为11.7%，相邻节段同时减压和颅侧相邻节段既往存在的椎管狭窄是ASD的危险因素。
