Center for Spinal Surgery, Schön Klinik Düsseldorf SE & Co. KG, Am Heerdter Krankenhaus 2, 40549 Düsseldorf, Germany.
Department of Orthopedic and Trauma Surgery, University Hospital of Cologne, Cologne, Germany.
Biomed Res Int. 2017;2017:2964529. doi: 10.1155/2017/2964529. Epub 2017 Jul 31.
The goal of this review is to identify criteria indicating implantation of hybrid system into lumbar spine and to evaluate general benefits of use.
A systematic review of literature was performed using current randomized clinical trials, reviews, and meta-analyses. Data sources included relevant literature of human studies identified through searches of Medline Library until May 2015.
Predisposing factors for Adjacent Segment Disease (ASDi) are discussed in literature: laminar horizontalization, insufficiency of fascia thoracolumbalis, facet tropism, and facet sagittalization. Currently there is no evidence for topping off. There are only 12 studies and these have no consistent statements about use of a hybrid system for avoidance of ASDi.
Hybrid instrumentation of lumbar spine, either with pedicle-based technique or additional spacer, might possibly prevent ASDi from developing in previously damaged segment adjacent to a fusion. Good clinical data proving effectiveness of this new implant technique is as yet unavailable. Thus, currently one must speak of an unevaluated procedure. Various radiological classifications can assist in making a reliable decision as to whether hybrid instrumentation is an appropriate choice of therapy. Pathoanatomical conditions of facet joints and laminae as well as preservation of sagittal balance must also be considered.
本综述旨在确定提示将混合系统植入腰椎的标准，并评估其使用的总体益处。
使用当前的随机临床试验、综述和荟萃分析对文献进行系统评价。资料来源包括通过对 Medline 图书馆的搜索，截至 2015 年 5 月确定的人类研究相关文献。
文献中讨论了导致邻近节段疾病（ASDi）的诱发因素：椎板水平化、胸腰椎筋膜不足、关节突关节倾斜和关节突矢状化。目前没有证据表明“顶端效应”的存在。仅有 12 项研究，但这些研究对于使用混合系统预防 ASDi 并没有一致的结论。
腰椎的混合器械固定，无论是基于椎弓根的技术还是附加的间隔物，都可能防止融合相邻的先前受损节段发生 ASDi。目前还没有证明这种新植入技术有效性的良好临床数据。因此，目前只能说这是一种未经评估的手术。各种影像学分类有助于可靠地决定混合器械固定是否是一种合适的治疗选择。关节突关节和椎板的病理解剖条件以及矢状平衡的保持也必须加以考虑。
