Otsuki Bungo, Fujibayashi Shunsuke, Tanida Shimei, Shimizu Takayoshi, Lyman Stephen, Matsuda Shuichi
Department of Orthopaedics, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Department of Orthopaedics, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
J Orthop Sci. 2019 Nov;24(6):957-962. doi: 10.1016/j.jos.2019.09.003. Epub 2019 Sep 21.
Only a few studies have described the effect of diffuse idiopathic skeletal hyperostosis (DISH) on the clinical results after lumbar surgery. The aim of the study is to clarify the associations between DISH and the clinical results after lumbar decompression surgery.
The outcomes of 328 consecutive patients who underwent primary lumbar decompression surgery for treatment of lumbar canal stenosis with or without grade I spondylolisthesis were analysed retrospectively. The major outcome measures were surgery-free survival and the need for further surgery because of same-segment disease (SSD) and/or adjacent-segment disease (ASD).
Of the 328 patients, 69 (60 men and nine women) were diagnosed with DISH. The Japanese Orthopaedic Association score before and at 1 year after the surgery did not differ significantly between patients with and without DISH. However, the rate of revision surgery in the follow-up period was significantly higher in patients with DISH than in those without (19% vs 6.9%, p = 0.0050). Cox proportional-hazards modelling revealed that DISH and sex (female) were independent risk factors for the need for revision surgery after decompression surgery for degenerative lumbar spine. The rate of revision surgery was higher in the sub-group of DISH with ossification extended to L2 or more than that for those with the ossification extended to L1 (26% vs 8%, p = 0.11), but the difference did not reach statistical significance.
DISH is a risk factor for revision surgery after decompression surgery for degenerative lumbar spine because of SSD and/or ASD.
仅有少数研究描述了弥漫性特发性骨肥厚（DISH）对腰椎手术后临床结果的影响。本研究的目的是阐明DISH与腰椎减压术后临床结果之间的关联。
回顾性分析328例因腰椎管狭窄症伴或不伴Ⅰ度椎体滑脱而接受初次腰椎减压手术的连续患者的结果。主要结局指标为无手术生存期以及因同节段疾病（SSD）和/或相邻节段疾病（ASD）而需要再次手术的情况。
在328例患者中，69例（60例男性和9例女性）被诊断为DISH。有DISH和无DISH的患者术前及术后1年的日本骨科协会评分差异无统计学意义。然而，随访期间DISH患者的翻修手术率显著高于无DISH的患者（19%对6.9%，p = 0.0050）。Cox比例风险模型显示，DISH和性别（女性）是退行性腰椎减压术后需要翻修手术的独立危险因素。骨化延伸至L2及以上的DISH亚组的翻修手术率高于骨化延伸至L1的亚组（26%对8%，p = 0.11），但差异未达到统计学意义。
由于SSD和/或ASD，DISH是退行性腰椎减压术后翻修手术的危险因素。
