腰椎经椎间孔腰椎体间融合术后相邻椎间盘高度降低现象。

Adjacent Intervertebral Disk Height Decrease Phenomenon After Single-Level Transforaminal Lumbar Interbody Fusion of the Lumbar Spine.

机构信息

Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai, China.

出版信息

World Neurosurg. 2019 Aug;128:e308-e314. doi: 10.1016/j.wneu.2019.04.141. Epub 2019 Apr 25.

DOI:10.1016/j.wneu.2019.04.141

PMID:31028983

Abstract

BACKGROUND

The increase of intradiskal pressure on the upper segment resulting from intervertebral distraction after lumbar intervertebral fusion decreases intervertebral height and aggravates degeneration. However, the incidence rate and risk factors of the adjacent intervertebral disk height decrease phenomenon have not been studied. The purpose of this study was to identify the incidence rate and risk factors of the adjacent intervertebral disk height decrease phenomenon after single-level transforaminal lumbar interbody fusion (TLIF) of the lumbar spine.

METHODS

A retrospection of 68 patients who underwent L4-5 TLIF. Patient age, sex, and body mass index were collected. Lumbar lordosis, facet sagittalization, Pfirrmann classification, L4-5 distraction height, and L3-4 reduction height were evaluated by radiologic image. The patients were divided into 2 groups based on whether their L3-4 intervertebral height decreased.

RESULTS

Forty of 68 patients (58.8%) had L3-4 intervertebral height decrease. The patients' mean age was 62.05 ± 10.90 years in the L3-4 intervertebral height decrease positive (IHDP) group, significantly higher than the 56.14 ± 12.06 years in the L3-4 intervertebral height decrease negative (IHDN) group (P = 0.039). The mean facet sagittalization angle in the IHDP group was 67.5° ± 20.36°, significantly larger than the 55.43° ± 14.97° in the IHDN group (P = 0.010). The preoperative lumbar lordosis was significantly higher in the IHDP group (P = 0.049). No significant effects of other factors on L3-4 height decrease were observed (P > 0.05).

CONCLUSIONS

Distraction of the L4-5 intervertebral space by cage insertion leads to a reduced height on the adjacent L3-4 segment in some patients. In addition, the decrease in L3-4 intervertebral height resulting from L4-5 distraction was correlated with age, preoperative lumbar lordosis, and facet joint sagittalization.

摘要

背景

腰椎融合术后，由于椎间撑开导致上位椎间盘内压力增加，从而导致椎间盘高度降低，加重椎间盘退变。然而，相邻椎间盘高度降低现象的发生率及危险因素尚未得到研究。本研究旨在探讨腰椎经椎间孔腰椎体间融合术（TLIF）后相邻椎间盘高度降低的发生率及危险因素。

方法

回顾性分析 68 例行 L4-5 TLIF 的患者。收集患者年龄、性别和体重指数。通过影像学图像评估腰椎前凸、小关节矢状化、Pfirrmann 分级、L4-5 撑开高度和 L3-4 降低高度。根据 L3-4 椎间盘高度是否降低，将患者分为 2 组。

结果

68 例患者中，40 例（58.8%）存在 L3-4 椎间盘高度降低。L3-4 椎间盘高度降低阳性（IHDP）组患者的平均年龄为 62.05 ± 10.90 岁，明显高于 L3-4 椎间盘高度降低阴性（IHDN）组的 56.14 ± 12.06 岁（P = 0.039）。IHDP 组小关节矢状化角度的平均为 67.5° ± 20.36°，明显大于 IHDN 组的 55.43° ± 14.97°（P = 0.010）。IHDP 组术前腰椎前凸明显较高（P = 0.049）。其他因素对 L3-4 高度降低无明显影响（P > 0.05）。