Department of Orthopaedic Surgery, Osaka Rosai Hospital, Osaka, Japan.
Spine (Phila Pa 1976). 2018 Dec 1;43(23):E1384-E1388. doi: 10.1097/BRS.0000000000002710.
A retrospective study.
The aim of this study was to investigate the incidence of adjacent segment disease (ASD) at 2, 5, and 10 years after primary posterior lumbar interbody fusion (PLIF), and clinical features of ASD.
Few reports have examined ASD after PLIF with more than 10 years of follow-up. Furthermore, no reports have examined limited conditions of preoperative pathology, fusion segment, and fusion method with long follow-up.
Data were reviewed for 128 patients who underwent single-segment PLIF for L4 degenerative spondylolisthesis and could be followed for at least 10 years. Mean age at the time of surgery was 63 years, and mean follow-up was 12.4 years. Follow-up rate was 62.4%. ASD was defined as radiological ASD (R-ASD), radiological degeneration adjacent to the fusion segment by plain X-rays and magnetic resonance imaging (MRI); symptomatic ASD (S-ASD), a symptomatic condition due to neurological deterioration at the adjacent segment degeneration; and operative ASD (O-ASD), S-ASD requiring revision surgery.
Incidences of each ASD at 2, 5, and 10 years after primary PLIF were 19%, 49%, and 75% for R-ASD, 6%, 14%, and 31% for S-ASD, and 5%, 9%, and 15% for O-ASD, respectively. O-ASD incidence was 24% at final follow-up. O-ASD peak was bimodal, at 2 and 10 years after primary PLIF. O-ASD was mainly observed at the cranial segment (77%), followed by the caudal segment (13%) and both cranial and caudal segments (10%). With respect to O-ASD pathology, degenerative spondylolisthesis was observed in 52%, spinal stenosis in 39%, and disc herniation in 10%.
Incidences of R-ASD, S-ASD, and O-ASD at 10 years after primary PLIF were 75%, 31%, and 15%, respectively. With respect to O-ASD pathology, degenerative spondylolisthesis at the cranial segment was the most frequent.
回顾性研究。
本研究旨在探讨初次后路腰椎体间融合（PLIF）后 2、5 和 10 年时邻近节段疾病（ASD）的发生率以及 ASD 的临床特征。
很少有研究报告在 PLIF 后进行超过 10 年的随访时出现 ASD。此外，没有报告在进行长期随访时，对术前病理、融合节段和融合方法进行了有限的检查。
对 128 例因 L4 退行性脊椎滑脱而行单节段 PLIF 且至少随访 10 年的患者进行了数据分析。手术时的平均年龄为 63 岁，平均随访时间为 12.4 年，随访率为 62.4%。ASD 定义为影像学 ASD（R-ASD），即平片和磁共振成像（MRI）显示融合节段邻近节段的影像学退变；症状性 ASD（S-ASD），即由于邻近节段退变导致神经功能恶化的症状性疾病；以及手术性 ASD（O-ASD），即需要翻修手术的 S-ASD。
初次 PLIF 后 2、5 和 10 年时，R-ASD 的发生率分别为 19%、49%和 75%，S-ASD 的发生率分别为 6%、14%和 31%，O-ASD 的发生率分别为 5%、9%和 15%。最终随访时 O-ASD 的发生率为 24%。O-ASD 的发病高峰呈双峰型，分别出现在初次 PLIF 后 2 年和 10 年。O-ASD 主要发生在颅侧节段（77%），其次是尾侧节段（13%）和颅侧及尾侧节段（10%）。O-ASD 病变方面，退行性脊椎滑脱占 52%，椎管狭窄占 39%，椎间盘突出占 10%。
初次 PLIF 后 10 年时 R-ASD、S-ASD 和 O-ASD 的发生率分别为 75%、31%和 15%。O-ASD 病变方面，颅侧节段的退行性脊椎滑脱最常见。
4 级。
