Department of Orthopedics, Orebro University School of Medical Sciences and Orebro University Hospital, Orebro, Sweden
Department of Orthopedics, Orebro University School of Medical Sciences and Orebro University Hospital, Orebro, Sweden.
BMJ Open. 2022 Dec 9;12(12):e067571. doi: 10.1136/bmjopen-2022-067571.
To identify rates of additional operation after the index operation for degenerative lumbar spine diseases.
Retrospective register study.
National outcome data from Swespine, the National Swedish spine register.
A total of 4705 patients who underwent one-level surgery for degenerative disk disease (DDD) or lumbar spinal stenosis (LSS) with or without degenerative spondylolisthesis (DS) between 1 January 2007 and 31 December 2010 were followed from 1 January 2007 to 31 December 2020 to record all cases of additional lumbar spine operations.
One-level spinal decompression and/or posterolateral fusion for degenerative spine diseases.
Number of additional operations.
Additional operations were more common at adjacent levels for patients with LSS with DS treated with decompression and fusion whereas additional operations were more evenly distributed between the index level and the adjacent levels for DDD treated with fusion and LSS with and without DS treated with decompression only. For patients younger than 60 years, treated with decompression and fusion for LSS with DS, the additional operations were evenly distributed between the index level and the adjacent levels.
There are different patterns of additional operations following the index procedure after surgery for degenerative spine diseases. Rigidity across previously mobile segments is not the only important factor in the development of adjacent segment disease (ASD) after spinal fusion, also the underlying disease and age may play parts in ASD development. The findings of this study can be used in the shared decision-making process when surgery is a treatment option for patients with degenerative lumbar spine diseases as the first operation may be the start of a series of additional spinal operations for other degenerative spinal conditions, either at the index level or at other spinal levels.
确定退行性腰椎疾病索引手术后的额外手术率。
回顾性登记研究。
全国性结果数据来自 Swespine，国家瑞典脊柱登记处。
2007 年 1 月 1 日至 2010 年 12 月 31 日期间，共有 4705 例患者接受了单节段手术治疗退行性椎间盘疾病（DDD）或腰椎椎管狭窄症（LSS），伴或不伴退行性脊椎滑脱症（DS），随访时间从 2007 年 1 月 1 日至 2020 年 12 月 31 日，记录所有额外腰椎手术病例。
单节段脊柱减压和/或后路融合治疗退行性脊柱疾病。
额外手术次数。
对于接受减压融合治疗的 LSS 伴 DS 患者，在邻近节段进行额外手术更为常见，而对于接受融合治疗的 DDD 患者以及仅接受减压治疗的 LSS 伴或不伴 DS 患者，额外手术则均匀分布在指数水平和邻近节段。对于 60 岁以下接受减压融合治疗的 LSS 伴 DS 患者，额外手术均匀分布在指数水平和邻近节段。
退行性脊柱疾病手术后，索引手术后的额外手术方式存在不同模式。脊柱融合后邻近节段疾病（ASD）的发展不仅仅是先前活动节段僵硬的重要因素，潜在疾病和年龄也可能在 ASD 发展中起作用。本研究的发现可用于退行性腰椎疾病患者手术治疗的共同决策过程，因为第一次手术可能是一系列其他退行性脊柱疾病的脊柱手术的开始，无论是在指数水平还是在其他脊柱水平。
