Michael Alex P, Weber Matthew W, Delfino Kristin R, Ganapathy Venkatanarayanan
1Division of Neurosurgery and.
2Center for Clinical Research, Southern Illinois University School of Medicine, Springfield, Illinois; and.
J Neurosurg Spine. 2019 Apr 19;31(2):209-216. doi: 10.3171/2019.2.SPINE18929. Print 2019 Aug 1.
While long-term studies have evaluated adjacent-segment disease (ASD) following posterior lumbar spine arthrodesis, no such studies have assessed the incidence and prevalence of ASD following axial lumbar interbody fusion (AxiaLIF). The aim of this study was to estimate the incidence of ASD following AxiaLIF.
The authors retrospectively reviewed the medical records of 149 patients who underwent two-level index AxiaLIF and had at least 2 years of radiographic and clinical follow-up. ASD and pre- and postoperative lumbar lordosis were evaluated in each patient. ASD was defined as both radiographic and clinically significant disease at a level adjacent to a previous fusion requiring surgical intervention. The mean duration of follow-up was 6.01 years.
Twenty (13.4%) of the 149 patients developed ASD during the data collection period. Kaplan-Meier analysis predicted a disease-free ASD survival rate of 95.3% (95% CI 90.4%-97.7%) at 2 years and 89.1% (95% CI 82.8%-93.2%) at 5 years for two-level fusion. A laminectomy adjacent to a fusion site was associated with 5.1 times the relative risk of developing ASD. Furthermore, the ASD group had significantly greater loss of lordosis than the no-ASD group (p = 0.033).
Following two-level AxiaLIF, the rate of symptomatic ASD warranting either decompression or arthrodesis was found to be 4.7% at 2 years and 10.9% at 5 years. Adjacent-segment decompression and postoperative loss of lumbar lordosis predicted future development of ASD. To the authors' knowledge, this is the largest reported cohort of patients to undergo two-level AxiaLIF in the United States.
虽然长期研究已对腰椎后路融合术后的相邻节段疾病（ASD）进行了评估，但尚无研究评估轴向腰椎椎间融合术（AxiaLIF）后ASD的发病率和患病率。本研究的目的是估计AxiaLIF术后ASD的发病率。
作者回顾性分析了149例行两级初次AxiaLIF手术且有至少2年影像学和临床随访资料的患者的病历。评估了每位患者的ASD以及术前和术后腰椎前凸情况。ASD被定义为在先前融合节段相邻水平出现的具有影像学和临床意义的疾病，且需要手术干预。平均随访时间为6.01年。
在数据收集期间，149例患者中有20例（13.4%）发生了ASD。Kaplan-Meier分析预测，两级融合术后2年ASD无病生存率为95.3%（95%可信区间90.4%-97.7%），5年为89.1%（95%可信区间82.8%-93.2%）。融合部位相邻的椎板切除术与发生ASD的相对风险增加5.1倍相关。此外，ASD组的前凸丢失明显大于无ASD组（p = 0.033）。
两级AxiaLIF术后，需要减压或融合的有症状ASD发生率在2年时为4.7%，5年时为10.9%。相邻节段减压和术后腰椎前凸丢失预示着未来ASD的发生。据作者所知，这是美国报道的接受两级AxiaLIF手术患者数量最多的队列。
