Department of Orthopaedics, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan.
Biomed Res Int. 2022 Mar 24;2022:5161503. doi: 10.1155/2022/5161503. eCollection 2022.
To investigate the influence on the adjacent segment degeneration (ASD) of short-segment lateral lumbar interbody fusion (LLIF) at 2 years postoperatively.
Ninety-seven consecutive patients who underwent one- or two-level LLIF were included from two institutions. We diagnosed radiographical adjacent segment degeneration with the appearance of adjacent spondylolisthesis (>3 mm) or deterioration of adjacent disk height (>3 mm) on plain radiographs or decrease of the intervertebral angle (>5 degrees). The differences between the two groups with and without radiographical ASD were investigated using univariate and multivariate analyses to determine the risk factors for ASD. The variables included extent of adjacent decompression, posterior fixation method (open method or percutaneous method), and facet violation on postoperative CT.
In total, 19 patients (19.6%) were diagnosed as radiographical ASD 2 years after surgery. Univariate analysis showed that the ASD (+) group had a high frequency of adjacent decompression (21.1 vs. 3.8%, = 0.035) compared with the ASD (-) group. There were no differences between the two groups in posterior fusion method (percutaneous method 42.1 vs. 57.7%, = 0.221) or facet joint violation (15.8 vs. 14.1%, = 0.860). The multivariate analysis found adjacent intervertebral decompression to be a risk factor for ASD 2 years after surgery (odds ratio: 9.95; 95% confidence interval: 1.2-82.1).
Adjacent intervertebral decompression was considered to be a potential risk factor for the development of ASD after spinal fusion with LLIF.
研究短节段侧路腰椎间融合术（LLIF）术后 2 年对邻近节段退变（ASD）的影响。
本研究共纳入了来自两家机构的 97 例连续行单节段或双节段 LLIF 的患者。我们通过 X 线平片诊断影像学邻近节段退变，包括邻近节段滑脱（>3mm）或邻近椎间盘高度恶化（>3mm）或椎间隙角减小（>5 度）。使用单变量和多变量分析来研究有和无影像学 ASD 两组之间的差异，以确定 ASD 的危险因素。这些变量包括邻近减压的范围、后路固定方法（开放方法或经皮方法）和术后 CT 上的关节突关节侵犯。
共有 19 例患者（19.6%）在术后 2 年被诊断为影像学 ASD。单变量分析显示，ASD（+）组的邻近减压频率明显高于 ASD（-）组（21.1%比 3.8%， = 0.035）。两组后路融合方法（经皮方法 42.1%比 57.7%， = 0.221）或关节突关节侵犯（15.8%比 14.1%， = 0.860）无差异。多变量分析发现邻近椎间减压是术后 2 年 ASD 的危险因素（比值比：9.95；95%置信区间：1.2-82.1）。
脊柱融合术后行 LLIF 时，邻近椎间减压被认为是 ASD 发生的潜在危险因素。
