Lee Kyu Yeol, Kim Min-Woo, Im Chul Soon, Jung Young Hoon
Department of Orthopedic Surgery, Dong-A University College of Medicine, Busan, Korea.
Asian Spine J. 2017 Aug;11(4):570-579. doi: 10.4184/asj.2017.11.4.570. Epub 2017 Aug 7.
Retrospective study.
We report the surgical outcomes of small degenerative lumbar scoliosis (DLS) patients treated by a short-segment fusion and followed for a minimum of 5 years.
Several surgical options are available for the treatment of DLS, such as decompression only, decompression plus a short-segment fusion, or decompression with a long segment fusion. Few studies have evaluated the results of a short-segment fusion in patients with DLS over time.
Seventy small DLS patients (Cobb's angle, 10°-25°) with a minimum follow-up of 5 years were treated with a short-segment fusion between March 2004 and February 2010. The mean patient age was 71 (male:female=16:54), with a follow-up of 6.5 years (range, 5.0-11.6). The Cobb's angle, 1 and 2 segment coronal upper intervertebral angle, 1 and 2 segment sagittal upper intervertebral angle, the lumbar lordosis angle, and the C7 plumb lines (coronal and sagittal) were evaluated using simple radiographs, and visual analog scale (VAS), back pain was assessed preoperatively, immediately after surgery, and at 3, 6, and 12 months and 3 and 5 years after surgery. To identify factors influencing the radiologic progression, age, number of fusion segments, vertebral levels of fusion, body mass index, lowest instrumented vertebra (L5 or S1), bone mineral density (>-2.5, ≤-2.5), and the presence of an interbody fusion were analyzed.
The Cobb's angle and 1 segment coronal upper intervertebral angle showed more progression during follow up, particularly at 6 and 12 months after surgery. Clinical outcomes and radiological results were found to be significantly associated (=0.041). No statistically significant association was found between other factors affecting radiologic progression from postoperative 6 months to 1 year.
Radiologic variables (the Cobb's angle and coronal upper intervertebral angle-1) should be carefully considered and clinical caution exercised from 6 to 12 months after short-segment fusion in small DLS (10°-25°).
回顾性研究。
我们报告了采用短节段融合术治疗的小型退行性腰椎侧弯（DLS）患者的手术结果，并对其进行了至少5年的随访。
治疗DLS有多种手术选择，如单纯减压、减压加短节段融合或减压加长节段融合。很少有研究评估DLS患者短节段融合术随时间推移的效果。
2004年3月至2010年2月期间，对70例小型DLS患者（Cobb角为10°-25°）进行了短节段融合术治疗，并进行了至少5年的随访。患者平均年龄为71岁（男:女 = 16:54），随访时间为6.5年（范围为5.0 - 11.6年）。使用简单的X线片评估Cobb角、第1和第2节段的冠状位上位椎间角、第1和第2节段的矢状位上位椎间角、腰椎前凸角以及C7铅垂线（冠状位和矢状位），并在术前、术后即刻、术后3、6、12个月以及术后3年和5年时通过视觉模拟量表（VAS）评估背痛情况。为确定影响影像学进展的因素，分析了年龄、融合节段数、融合的椎体节段、体重指数、最低固定椎体（L5或S1）、骨密度（>-2.5，≤-2.5）以及椎间融合的情况。
Cobb角和第1节段冠状位上位椎间角在随访期间进展更多，尤其是在术后6个月和12个月时。发现临床结果与影像学结果显著相关（P = 0.041）。术后6个月至1年，在影响影像学进展的其他因素之间未发现统计学上的显著关联。
对于小型DLS（10°-25°）患者进行短节段融合术后6至12个月期间，应仔细考虑影像学变量（Cobb角和冠状位上位椎间角-1）并谨慎对待临床情况。
