Health Sciences University, School of Medicine, Department of Neurosurgery, Istanbul, Turkey; FSM Training and Research Hospital, Neurosurgery Clinic, Istanbul, Turkey.
FSM Training and Research Hospital, Neurosurgery Clinic, Istanbul, Turkey.
J Clin Neurosci. 2024 Nov;129:110849. doi: 10.1016/j.jocn.2024.110849. Epub 2024 Sep 19.
Recent spine studies focused on identifying whether intradiscal vacuum phenomenon (VP) was associated with spinal instability. However, none of them reported a direct association between VP and spinal instability following fusion for degenerative lumbar spine disorders (DSDs), namely junctional disorders. In the present study, we aimed to evaluate whether the VP was predictive for junctional disorders in patients who underwent short-segment lumbar decompression and fusion for DSDs at a tertiary spine center. We retrospectively reviewed prospectively collected database of patients who underwent short-segment decompression and fusion for DSDs. Pre-operative sagittal and axial computed tomography (CT) scans were evaluated in terms of intradiscal and intrafacet VP at all lumbar levels, respectively. Each VP was scored as 1 point. Then, the total VP score was calculated as the sum of intradiscal VP score and intrafacet VP score. Then, we analyzed the possible predictivity of VP for junctional disorders at final follow-ups of the patients operated for short-segment lumbar decompression and fusion. Patients with junctional disorders had significantly higher total and intrafacet VP scores compared to those without junctional disorders. Total VP score had an OR of 1.217 (p = 0.014) and intrafacet VP score had an OR of 1.465 (p = 0.008). The ROC analysis depicted that the cut-offs value for total and intrafacet VP scores to predict junctional disorders following short-segment lumbar decompression and fusion were 1.5 points and 0.5 point, respectively. Vacuum phenomenon could be associated with junctional disorders in patients who underwent short-segment lumbar decompression and fusion for DSD. Intrafacet VP was more important than intradiscal VP in predicting junctional disorders. Proper surgical planning including the evaluation of both intrafacet and intradiscal VP at all lumbar levels is crucial to decrease the likelihood of junctional disorders.
近期的脊柱研究集中于确定椎间盘内真空现象（VP）是否与脊柱不稳定有关。然而，在退行性腰椎疾病（DSD）融合后，即交界性疾病，没有一项研究报告 VP 与脊柱不稳定之间存在直接关联。在本研究中，我们旨在评估在三级脊柱中心接受短节段减压融合治疗 DSD 的患者中，VP 是否可预测交界性疾病。我们回顾性分析了在三级脊柱中心接受短节段减压融合治疗 DSD 的患者前瞻性收集的数据库。分别评估所有腰椎水平的椎间盘内和小关节内 VP 的术前矢状位和轴向 CT 扫描。每个 VP 记 1 分。然后，将椎间盘内 VP 评分和小关节内 VP 评分相加，计算总 VP 评分。然后，我们分析了在接受短节段腰椎减压融合术的患者最终随访时 VP 对交界性疾病的预测能力。与无交界性疾病的患者相比，交界性疾病患者的总 VP 和小关节内 VP 评分显著更高。总 VP 评分的 OR 为 1.217（p=0.014），小关节内 VP 评分的 OR 为 1.465（p=0.008）。ROC 分析表明，总 VP 和小关节内 VP 评分预测短节段腰椎减压融合术后交界性疾病的截断值分别为 1.5 分和 0.5 分。VP 可能与接受短节段腰椎减压融合术治疗 DSD 的患者的交界性疾病有关。小关节内 VP 比椎间盘内 VP 更能预测交界性疾病。适当的手术计划，包括评估所有腰椎水平的小关节内和椎间盘内 VP，对于降低交界性疾病的可能性至关重要。
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