Ding H T, Hai Y, Liu Y Z, Guan L, Liu T, Pan A X, Han B
Department of orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China.
Zhonghua Yi Xue Za Zhi. 2020 Nov 24;100(43):3437-3442. doi: 10.3760/cma.j.cn112137-20200417-01218.
To compare the degenerative changes of adjacent segments after posterior lumbar fusion surgery using cortical bone trajectory (CBT) screws and pedicle screws (PS) in lumbar spinal degenerative disease. According to certain inclusion and exclusion criteria, prospective non-randomized study on cases of the single-segment lumbar spinal fusion surgery using cortical bone trajectory screws fixation and pedicle screws fixation in Beijing Chao-Yang Hospital from January 2015 to February 2016 was performed. The intervertebral space height (ISH), foramen height (FH), foramen width (FW), cephalad adjacent segment (CAS) and intervertebral disc degeneration grades at MRI scans were measured before surgery and during follow-up. Clinical symptoms were evaluated by Oswestry Dysfunction Index (ODI) score and pain visual analogue scale (VAS) before and during the follow-up. Radiologic adjacent segment degeneration (R-ASD) and symptomatic adjacent segment disease (S-ASD) patients were diagnosed during the follow-up. Paired sample test was performed when data were compared before surgery and during follow-up. A total of 69 patients were included in the study, 33 in the CBT group (male/female, 15/18), with an average age of (65±11) years, and 36 in the PS group (male/female, 17/19), with an average age of (64±10) years. The follow-up time was no less than 36 months. At the last follow-up, the ISH of the adjacent segments in the CBT group were not statistically different from that before surgery; the ISH of the adjacent segments in the PS group were significantly reduced compared with that before surgery (6.78, 0.05). The loss of ISH, FH, and FW in the adjacent segments in the CBT group were smaller than those in the PS group, and the differences were statistically significant. During follow-up, 4 cases (12.1%) of R-ASD and no S-ASD were found in the CBT group, while 12 cases (33.3%) of R-ASD appeared in the PS group, which was significantly higher than that in the CBT group (χ(2)=4.35, 0.04). According to MRI, the adjacent discs of PS group had significantly more severe degeneration at the last follow-up than the CBT group (-2.14, 0.03). Compared with the PS fixation fusion, the CBT screw fixation can effectively reduce the occurrence of adjacent segment degeneration.
比较腰椎退行性疾病患者行后路腰椎融合手术时，使用皮质骨轨迹（CBT）螺钉和椎弓根螺钉（PS）后相邻节段的退变情况。根据一定的纳入和排除标准，对2015年1月至2016年2月在北京朝阳医院行单节段腰椎融合手术采用皮质骨轨迹螺钉固定和椎弓根螺钉固定的病例进行前瞻性非随机研究。在手术前及随访期间测量MRI扫描时的椎间隙高度（ISH）、椎间孔高度（FH）、椎间孔宽度（FW）、上位相邻节段（CAS）及椎间盘退变分级。在随访前及随访期间通过Oswestry功能障碍指数（ODI）评分和疼痛视觉模拟量表（VAS）评估临床症状。随访期间诊断放射性相邻节段退变（R-ASD）和症状性相邻节段疾病（S-ASD）患者。比较手术前及随访期间的数据时采用配对样本检验。本研究共纳入69例患者，CBT组33例（男/女，15/18），平均年龄（65±11）岁，PS组36例（男/女，17/19），平均年龄（64±10）岁。随访时间不少于36个月。在最后一次随访时，CBT组相邻节段的ISH与手术前相比无统计学差异；PS组相邻节段的ISH与手术前相比显著降低（6.78，0.05）。CBT组相邻节段ISH、FH和FW的丢失小于PS组，差异有统计学意义。随访期间，CBT组发现4例（12.1%）R-ASD且无S-ASD，而PS组出现12例（33.3%）R-ASD，显著高于CBT组（χ(2)=4.35，0.04）。根据MRI，在最后一次随访时PS组相邻椎间盘退变明显比CBT组严重（-2.14，0.03）。与PS固定融合相比，CBT螺钉固定可有效减少相邻节段退变的发生。
