腰椎融合术相邻节段减压是否会使患者易患相邻节段退变和疾病：一项回顾性分析。

Does decompression adjacent to arthrodesis in the lumbar spine predispose patients to adjacent segment degeneration and disease: A retrospective analysis.

作者信息

Paziuk Taylor, Neuman Brian J, Conaway William, Kothari Parth, Henry Tyler W, Kepler Christopher K, Schroeder Gregory D, Vaccaro Alexander R, Hilibrand Alan S

机构信息

Rothman Orthopaedic Institute, Thomas Jefferson University, 925 Chestnut Street 5th Floor, Philadelphia, PA, 19107, USA.

Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD, 21287, USA.

出版信息

J Orthop. 2023 Apr 25;40:52-56. doi: 10.1016/j.jor.2023.04.009. eCollection 2023 Jun.

DOI:10.1016/j.jor.2023.04.009

PMID:37188147

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10172830/

Abstract

BACKGROUND

The treatment for multi-level spinal stenosis in the setting of single-level instability is a common operative scenario for surgeons who treat degenerative lumbar spine pathology. However, there is conflicting evidence regarding the inclusion of adjacent "stable" levels in the arthrodesis construct because of the potential for iatrogenic instability placed on those segments with decompressive laminectomy alone. This study aims to determine whether decompression adjacent to arthrodesis in the lumbar spine is a risk factor for adjacent segment disease (AS Disease).

METHODS

A retrospective analysis identified consecutive patients over a three-year period who underwent single-level posterolateral lumbar fusion (PLF) in the setting of single or multi-level spinal stenosis. Patients were required to have a minimum of two-year follow-up. AS Disease was defined as the development of new radicular symptoms referable to a motion segment adjacent to the lumbar arthrodesis construct. The incidence of AS Disease and reoperation rates were compared between cohorts.

RESULTS

133 patients met the inclusion criteria with an average follow-up of 54 months. Fifty-four patients had a PLF with adjacent segment decompression, and 79 underwent a single-segment decompression and PLF. 24.1% (13/54) of patients who had a PLF with adjacent level decompression developed AS Disease resulting in a 5.5% (3/54) reoperation rate. 15.2% (12/79) of patients who did not receive an adjacent level decompression developed AS Disease resulting in a reoperation rate of 7.5% (6/79). There was neither a significantly higher rate of AS Disease (p = 0.26) nor reoperation (p = 0.74) between the cohorts.

CONCLUSIONS

Decompression adjacent to single-level PLF was not associated with an increased rate of AS Disease relative to single-level decompression and PLF.

摘要

背景

对于治疗退行性腰椎疾病的外科医生而言，在单节段不稳定情况下治疗多节段腰椎管狭窄是一种常见的手术情况。然而，关于在融合固定结构中纳入相邻“稳定”节段存在相互矛盾的证据，因为仅行减压性椎板切除可能会给这些节段带来医源性不稳定。本研究旨在确定腰椎融合固定术相邻节段减压是否为相邻节段疾病（AS疾病）的危险因素。

方法

一项回顾性分析确定了连续三年期间因单节段或多节段腰椎管狭窄接受单节段腰椎后外侧融合术（PLF）的患者。患者需至少有两年的随访。AS疾病定义为与腰椎融合固定结构相邻的运动节段出现新的神经根性症状。比较各队列中AS疾病的发生率和再次手术率。

结果

133例患者符合纳入标准，平均随访54个月。54例患者接受了PLF并进行了相邻节段减压，79例患者接受了单节段减压和PLF。接受相邻节段减压的PLF患者中有24.1%（13/54）发生了AS疾病，导致再次手术率为5.5%（3/54）。未接受相邻节段减压的患者中有15.2%（12/79）发生了AS疾病，导致再次手术率为7.5%（6/79）。各队列之间AS疾病发生率（p = 0.26）和再次手术率（p = 0.74）均无显著升高。