Qu Changpeng, Guo Jianwei, Tao Hao, Zhou Chuanli, Zhu Kai, Sun Yihao, Li Lei, Liu Zhiming, Zhang Hao, Ma Xuexiao
The Affiliated Hospital of Qingdao University, Department of Spinal Surgery, Qingdao, Shandong, China.
The Affiliated Hospital of Qingdao University, Department of Trauma Surgery, Qingdao, Shandong, China.
Orthop Surg. 2025 May;17(5):1418-1432. doi: 10.1111/os.70029. Epub 2025 Mar 20.
The degeneration characteristics of adjacent segment disease are complex. Improper surgical planning has caused unnecessary surgical trauma and costs. The purpose of this study was to establish a staging system for adjacent segment disease and evaluate its guiding significance for surgical decisions in adjacent segment disease.
A retrospective study was performed on 103 patients with adjacent segment disease who underwent treatment between January 2017 and January 2023. Based on radiological findings, adjacent segment disease was categorized into four stages, with no cases identified in Stage IV. Patients were divided into four intervention groups: Group A (control group, traditional posterior lumbar fusion with rod-screw revision), Group B (Stage I, percutaneous endoscopic decompression), Group C (Stage II, oblique lumbar interbody fusion), and Group D (Stage III, cortical bone trajectory screws with posterior lumbar interbody fusion). Clinical and radiological outcomes were evaluated postoperatively, at 3 months, and at 12 months. Statistical analysis was conducted using t-tests, Mann-Whitney U tests, chi-square tests, and Spearman's correlation.
Surgical expenses, duration, estimated blood loss, postoperative hospital stays, disc height index, and Pfirrmann grading all demonstrated significant correlations with the established grading system (p < 0.05). Patients achieved favorable clinical outcomes. Specifically, Groups B, C, and D showed earlier functional recovery compared to Group A, with Groups B and C experiencing more rapid relief from low back pain. Furthermore, Groups B, C, and D had shorter surgical times and reduced blood loss, while Groups B and C also incurred lower surgical costs and shorter hospital stays (p < 0.05).
The new grading system, developed based on the characteristics of adjacent segment degeneration, showed excellent surgical adaptability, despite varying degrees of correlation across different factors. This system was closely linked to the degree of intervertebral disc degeneration and the intervertebral disc height index. All patients achieved favorable surgical outcomes, suggesting that this grading system could provide valuable guidance in making surgical treatment decisions.
相邻节段疾病的退变特征复杂。不当的手术规划会造成不必要的手术创伤和费用。本研究的目的是建立一种相邻节段疾病的分期系统，并评估其对相邻节段疾病手术决策的指导意义。
对2017年1月至2023年1月期间接受治疗的103例相邻节段疾病患者进行回顾性研究。根据影像学表现，将相邻节段疾病分为四个阶段，IV期未发现病例。患者分为四个干预组：A组（对照组，传统后路腰椎融合并棒-螺钉翻修）、B组（I期，经皮内镜减压）、C组（II期，斜外侧腰椎椎间融合）和D组（III期，皮质骨轨迹螺钉结合后路腰椎椎间融合）。术后、3个月和12个月时评估临床和影像学结果。采用t检验、Mann-Whitney U检验、卡方检验和Spearman相关性分析进行统计分析。
手术费用、手术时长、估计失血量、术后住院时间、椎间盘高度指数和Pfirrmann分级均与所建立的分级系统显示出显著相关性（p < 0.05）。患者获得了良好的临床结果。具体而言，B组、C组和D组与A组相比功能恢复更早，B组和C组下腰痛缓解更快。此外，B组、C组和D组手术时间更短、失血量减少，而B组和C组手术费用也更低、住院时间更短（p < 0.05）。
基于相邻节段退变特征开发的新分级系统，尽管不同因素间的相关性程度各异，但显示出了出色的手术适应性。该系统与椎间盘退变程度和椎间盘高度指数密切相关。所有患者均获得了良好的手术效果，表明该分级系统可为手术治疗决策提供有价值的指导。
