National Center for Spinal Disorders.
In Silico Biomechanics Laboratory, National Center for Spinal Disorders, Buda Health Center.
Clin Spine Surg. 2023 Aug 1;36(7):E306-E310. doi: 10.1097/BSD.0000000000001369. Epub 2022 Aug 10.
Prospective cross-sectional cohort study.
The main purpose of this study was to evaluate the association between demographical, surgery-related and morphologic parameters, and the development or progress of adjacent segment degeneration (ASD) after short-segment lumbar fusions.
ASD is a major long-term complication after lumbar fusions. Possible risk factors are related to the patients' demographics, spinopelvic anatomy, or preoperative lumbar intervertebral disk conditions, but the role of these parameters is still not clear.
A prospective cross-sectional study of 100 patients who underwent 1- or 2-level open lumbar transforaminal interbody fusions due to a lumbar degenerative pathology was conducted. Demographical, radiologic findings, and magnetic resonance imaging features were analyzed to identify factors associated with ASD in 5-year follow-up.
ASD patients showed higher level of pain ( P =0.004) and disability ( P =0.020) at follow-up. In univariate analysis, older age ( P =0.007), upper-level lumbar fusion ( P =0.007), lower L4-S1 lordosis ( P =0.039), pelvic incidence-lumbar lordosis mismatch ( P =0.021), Pfirrmann grade III or higher disk degeneration ( P =0.002), and the presence of disk bulge/protrusion ( P =0.007) were associated with ASD. In multivariate analysis, the presence of major degenerative sign (disk degeneration and/or disk bulge) was the significant predictor for developing ASD (odds ratio: 3.85, P =0.006).
By examining the role of different patient- and procedure-specific factors, we found that preoperative major degenerative signs at the adjacent segment increase the risk of ASD causing significantly worse outcome after short-segment lumbar fusion. On the basis of our results, adjacent disk conditions should be considered carefully during surgical planning.
前瞻性横断面队列研究。
本研究的主要目的是评估人口统计学、手术相关和形态学参数与短节段腰椎融合术后邻近节段退变（ASD）的发展或进展之间的关系。
ASD 是腰椎融合术后的主要长期并发症。可能的危险因素与患者的人口统计学、脊柱骨盆解剖结构或术前腰椎间盘状况有关，但这些参数的作用尚不清楚。
对 100 例因腰椎退行性病变行 1 或 2 级开放式经椎间孔腰椎体间融合术的患者进行前瞻性横断面研究。分析人口统计学、影像学发现和磁共振成像特征，以确定 5 年随访时与 ASD 相关的因素。
ASD 患者在随访时疼痛（P=0.004）和残疾（P=0.020）水平更高。单因素分析显示，年龄较大（P=0.007）、上腰椎融合（P=0.007）、较低的 L4-S1 前凸（P=0.039）、骨盆入射角-腰椎前凸不匹配（P=0.021）、Pfirrmann 分级 III 级或更高级别的椎间盘退变（P=0.002）以及存在椎间盘膨出/突出（P=0.007）与 ASD 相关。多因素分析显示，主要退行性征象（椎间盘退变和/或椎间盘膨出）的存在是发生 ASD 的显著预测因素（优势比：3.85，P=0.006）。
通过检查不同患者和手术特定因素的作用，我们发现相邻节段的术前主要退行性征象增加了短节段腰椎融合术后发生 ASD 的风险，导致明显较差的结果。基于我们的结果，在手术规划时应仔细考虑相邻椎间盘的状况。
