Choi Woo-Jin, Kim Seung-Kook, Alaraj Manhal, Kim Hyeun-Sung, Lee Su-Chan
Department of Neurosurgery, Spine Center, Hurisarang Hospital, 618 Gyeryong-ro, Seo-gu, Daejeon 35299, Korea.
Himchan and UHS Spine and Joint Centre, Neurosurgery, University Hospital Sharjah, University Street 1, Sharjah 72772, United Arab Emirates.
Medicina (Kaunas). 2021 Mar 4;57(3):237. doi: 10.3390/medicina57030237.
: Symptomatic adjacent segment degeneration (ASD) with lumbar spinal canal stenosis (LSCS) is a common complication after spinal intervention, particularly interbody fusion. Stand-alone posterior expandable cages enable interbody fusion with preservation of the previous operation site, and screw-related complications are avoided. Thus, the aim of this study was to investigate the clinicoradiologic outcomes of stand-alone posterior expandable cages for ASD with LSCS. : Patients with persistent neurologic symptoms and radiologically confirmed ASD with LSCS were evaluated between January 2011 and December 2016. The five-year follow-up data were used to evaluate the long-term outcomes. The radiologic parameters for sagittal balance, pain control (visual analogue scale), disability (Oswestry Disability Index), and early (peri-operative) and late (implant) complications were evaluated. : The data of 19 patients with stand-alone posterior expandable cages were evaluated. Local factors, such as intervertebral and foraminal heights, were significantly corrected ( < 0.01 and < 0.01, respectively), and revision was not reported. The pain level ( < 0.01) and disability rate ( < 0.01) significantly improved, and the early complication rate was low ( = 2, 10.52%). However, lumbar lordosis ( = 0.62) and sagittal balance ( = 0.80) did not significantly improve. Furthermore, the rates of subsidence ( = 4, 21.05%) and retropulsion ( = 3, 15.79%) were high. : A stand-alone expandable cage technique should only be considered for older adults and patients with previous extensive fusion. Although this technique is less invasive, improves the local radiologic factors, and yields favorable clinical outcomes with low revision rates, it does not improve the sagittal balance. For more widespread application, the strength of the cage material and high subsidence rates should be improved.
有症状的相邻节段退变（ASD）合并腰椎管狭窄症（LSCS）是脊柱干预术后的常见并发症，尤其是椎体间融合术后。独立的后路可扩张椎间融合器可实现椎体间融合，同时保留先前的手术部位，并避免螺钉相关并发症。因此，本研究的目的是探讨独立后路可扩张椎间融合器治疗ASD合并LSCS的临床和影像学结果。：2011年1月至2016年12月期间，对有持续性神经症状且经影像学证实为ASD合并LSCS的患者进行了评估。采用五年随访数据评估长期结果。评估矢状面平衡、疼痛控制（视觉模拟评分）、功能障碍（Oswestry功能障碍指数）以及早期（围手术期）和晚期（植入物）并发症的影像学参数。：对19例使用独立后路可扩张椎间融合器的患者的数据进行了评估。局部因素，如椎间隙高度和椎间孔高度，得到了显著改善（分别为P<0.01和P<0.01），且未报告翻修情况。疼痛水平（P<0.01）和功能障碍率（P<0.01）显著改善，早期并发症发生率较低（n = 2，10.52%）。然而，腰椎前凸（P = 0.62）和矢状面平衡（P = 0.80）未显著改善。此外，下沉率（n = 4，21.05%）和后凸率（n = 3，15.79%）较高。：独立可扩张椎间融合器技术仅应考虑用于老年人和先前有广泛融合的患者。尽管该技术侵入性较小，可改善局部影像学因素，并能获得低翻修率的良好临床结果，但它并不能改善矢状面平衡。为了更广泛地应用，应提高椎间融合器材料的强度并降低高下沉率。
