Hiratsuka Shigeto, Takahata Masahiko, Hojo Yoshihiro, Kajino Tomomichi, Hisada Yuichiro, Iwata Akira, Yamada Katsuhisa, Iwasaki Norimasa
Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
J Orthop Sci. 2019 Jan;24(1):14-18. doi: 10.1016/j.jos.2018.08.002. Epub 2018 Aug 23.
Lumbar decompression surgery is a commonly used treatment for degenerative lumbar spinal stenosis; however, some patients develop symptomatic spinal instability following decompression surgery. The objective of this study was to reveal risk factors for delayed instability following decompression surgery for lumbar spinal stenosis.
One hundred ten patients who underwent single-level lumbar decompression between 2008 and 2014 were retrospectively reviewed. Surgical indication for decompression surgery was symptomatic lumbar canal stenosis without spondylolisthesis or with minimum spondylolisthesis (less than 4 mm translation). Patients with gross segmental motion (>10° in disc angle, >2 mm translation) on flexion-extension lumbar radiographs were excluded. Age, sex, body mass index, smoking history, diabetes mellitus, autoimmune connective tissue diseases including rheumatoid arthritis, and the use of glucocorticoids were investigated. Radiographic measurements included disc angle, disc height, slippage, facet angle, segmental motion (flexion-extension), lumbar alignment, facet effusion, and disc degeneration. Data were analyzed using multivariate forward selection stepwise logistic regression, chi-square tests, and Student t-test.
Six of 110 patients (5.5%) developed symptomatic spinal instability at the operative level and underwent spinal fusion surgery at an average of 2.1 years postoperatively. Autoimmune connective tissue disorders and chronic use of glucocorticoids were associated with the occurrence of symptomatic spinal instability requiring spine fusion surgery, while there was no significant difference in radiographic parameters and demographic factors excluding autoimmune connective tissue diseases between reoperation and non-reoperation groups.
Patients with autoimmune connective tissue disorders receiving chronic glucocorticoid therapy are more likely to develop symptomatic spinal instability following decompression surgery for lumbar canal stenosis without or with minimal spondylolisthesis.
腰椎减压手术是治疗退行性腰椎管狭窄症的常用方法；然而，一些患者在减压手术后会出现有症状的脊柱不稳定。本研究的目的是揭示腰椎管狭窄症减压手术后延迟性不稳定的危险因素。
回顾性分析2008年至2014年间接受单节段腰椎减压手术的110例患者。减压手术的手术指征为有症状的腰椎管狭窄症，无椎体滑脱或椎体滑脱程度最小（平移小于4毫米）。腰椎屈伸位X线片上出现明显节段性活动（椎间盘角度>10°，平移>2毫米）的患者被排除。调查了患者的年龄、性别、体重指数、吸烟史、糖尿病、包括类风湿关节炎在内的自身免疫性结缔组织疾病以及糖皮质激素的使用情况。影像学测量包括椎间盘角度、椎间盘高度、滑脱、小关节角度、节段性活动（屈伸）、腰椎排列、小关节积液和椎间盘退变。采用多因素向前选择逐步逻辑回归、卡方检验和学生t检验进行数据分析。
110例患者中有6例（5.5%）在手术节段出现有症状的脊柱不稳定，并在术后平均2.1年接受了脊柱融合手术。自身免疫性结缔组织疾病和长期使用糖皮质激素与需要脊柱融合手术的有症状脊柱不稳定的发生有关，而再手术组和非再手术组之间，除自身免疫性结缔组织疾病外的影像学参数和人口统计学因素无显著差异。
接受长期糖皮质激素治疗的自身免疫性结缔组织疾病患者，在进行无或有最小椎体滑脱的腰椎管狭窄症减压手术后，更有可能出现有症状的脊柱不稳定。
