Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui 910-1193, Japan.
Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui 910-1193, Japan.
Spine J. 2021 Jun;21(6):955-962. doi: 10.1016/j.spinee.2021.01.009. Epub 2021 Jan 13.
Diffuse idiopathic skeletal hyperostosis (DISH) is a risk factor for further surgery after posterior decompression without fusion for patients with lumbar spinal canal stenosis (LSS). However, a strategy to prevent revision surgery has not been described.
The aim of this study was to review clinical and imaging findings in LSS patients with DISH extending to the lumbar segment and to propose countermeasures for prevention of revision surgery.
A retrospective study.
A total of 613 consecutive patients with LSS underwent posterior decompression without fusion at our hospital and had a minimum follow-up period of 2 years. We defined patients with DISH bridging to the lumbar segment as L-DISH cases (group D, n=111), and those without as non-L-DISH cases (group N, n=502).
Demographic data including the rate of revision surgery, neurological examination using Japanese Orthopaedic Association score, radiological studies comprised plain lumbar radiography, CT, and high-resolution MRI were assessed.
Clinical features and imaging findings were compared in patients with and without L-DISH. Revision surgery and surgical procedures (conventional laminotomy or lumbar spinous process-splitting [split] laminotomy) were examined in the two groups. No funding was received for this study.
L-DISH from L2 to L4 was a risk factor for disc degeneration such as a vacuum phenomenon and for further surgical treatment. The rate of revision surgery was higher in group D than in group N (9.0% vs. 4.0%, p=.026). There was no significant difference in this rate for patients in groups D and N who underwent conventional laminotomy; however, for those who underwent split laminotomy, the rate was significantly higher in group D (16.7% vs. 2.1%, p=.0006). Furthermore, the rate of revision surgery after split laminotomy at a lower segment adjacent to L-DISH was significantly higher than that after conventional laminotomy (37.5% vs. 7.7%, p=.037).
A negative impact of lumbar spinous process-splitting laminotomy was found, especially with decompression at a lower segment adjacent to L-DISH. In such cases, surgery sparing the osteoligamentous structures at midline, including the spinous process and supra- and interspinous ligaments, should be selected.
弥漫特发性骨肥厚（DISH）是腰椎管狭窄症（LSS）患者后路减压而不融合后进一步手术的危险因素。然而，还没有描述预防翻修手术的策略。
本研究旨在回顾 DISH 延伸至腰椎节段的 LSS 患者的临床和影像学发现，并提出预防翻修手术的对策。
回顾性研究。
共有 613 例连续的 LSS 患者在我院接受后路减压而不融合，随访时间至少 2 年。我们将 DISH 桥接至腰椎节段的患者定义为 L-DISH 病例（D 组，n=111），而无 DISH 的患者定义为非-L-DISH 病例（N 组，n=502）。
评估了包括翻修手术率在内的人口统计学数据、日本矫形协会评分的神经学检查、包括腰椎平片、CT 和高分辨率 MRI 的影像学研究。
比较了 L-DISH 患者和非 L-DISH 患者的临床特征和影像学发现。检查了两组患者的翻修手术和手术方式（常规椎板切开术或腰椎棘突劈开术）。本研究未获得任何资金支持。
L2 至 L4 的 L-DISH 是椎间盘退变（如真空现象）和进一步手术治疗的危险因素。D 组的翻修手术率高于 N 组（9.0% vs. 4.0%，p=.026）。在接受常规椎板切开术的 D 组和 N 组患者中，这一比率没有显著差异；然而，在接受劈开椎板切开术的患者中，D 组的比率明显更高（16.7% vs. 2.1%，p=.0006）。此外，L-DISH 相邻下段劈开椎板切开术的翻修手术率明显高于常规椎板切开术（37.5% vs. 7.7%，p=.037）。
发现腰椎棘突劈开术有负面影响，特别是在 L-DISH 相邻下段减压时。在这种情况下，应选择保留中线的骨韧带结构的手术，包括棘突和棘上及棘间韧带。
