Department of Neurosurgery, Takeda General Hospital, Fushimi, Kyoto, Japan.
Department of Neurosurgery, Takeda General Hospital, Fushimi, Kyoto, Japan.
World Neurosurg. 2020 Dec;144:e110-e118. doi: 10.1016/j.wneu.2020.08.012. Epub 2020 Sep 23.
Few studies have examined the underlying cause of adjacent segment disease (ASD) after decompression surgery for lumbar spinal stenosis. The goal of this study is to investigate factors related to the onset of ASD after decompression surgery based on the imaging results.
We examined 95 patients who underwent single-level decompression for lumbar spinal stenosis (L3/4, L4/5) and follow-up for 5 or more years. Radiographic images were performed preoperatively and at each year of follow-up. We then examined image parameters by focusing on the level operated on and adjacent segments in relation to the postoperative onset of symptomatic ASD.
During the mean observation period of 7.5 years, 39 of 95 patients developed symptomatic ASD. Patients with a high preoperative sagittal rotation angle in adjacent segments possibly developed postoperative ASD (P = 0.0006). Furthermore, postoperative ASD tended to be unlikely in patients who exhibited postoperative slip progression at the operated level (P = 0.025). Based on receiver operating characteristic analysis, ASD developed with a probability of 91.3% in patients with a preoperative sagittal rotation angle of ≥7.5° in adjacent segments when there was no postoperative slip progression at the operated level. However, ASD developed in only 16.7% of patients with a preoperative adjacent segment sagittal rotation angle of 7.5° or less when there was postoperative slip progression at the operated level.
Biomechanical changes at the operated level and adjacent segments contribute to the onset of ASD after lumbar decompression. Preoperative high sagittal rotation angle of adjacent segments and negative postoperative slip progression at the operated level are risk factors of ASD.
鲜有研究探讨腰椎管狭窄减压术后邻近节段疾病（ASD）的潜在病因。本研究旨在根据影像学结果，探讨与减压术后 ASD 发病相关的因素。
我们对 95 例行单节段减压术治疗腰椎管狭窄症（L3/4、L4/5）的患者进行了检查，并随访 5 年以上。术前及随访每年进行影像学检查。然后，我们重点关注手术节段及与术后症状性 ASD 发病相关的邻近节段的影像学参数。
在平均 7.5 年的观察期内，95 例患者中有 39 例发生了症状性 ASD。邻近节段术前矢状面旋转角度高的患者可能发生术后 ASD（P=0.0006）。此外，在手术节段出现术后滑脱进展的患者中，术后 ASD 不太可能发生（P=0.025）。基于受试者工作特征曲线分析，当手术节段无术后滑脱进展时，术前邻近节段矢状面旋转角度≥7.5°的患者发生 ASD 的概率为 91.3%；而当手术节段出现术后滑脱进展时，术前邻近节段矢状面旋转角度为 7.5°或更低的患者发生 ASD 的概率仅为 16.7%。
手术节段和邻近节段的生物力学变化导致腰椎减压术后 ASD 的发生。术前邻近节段矢状面旋转角度高和手术节段术后无滑脱进展是 ASD 的危险因素。
