Ye Bin, Ma Yachao, Tu Zhipeng, Huang Peipei, Yao Zhou, Wang Zhe, Luo Zhuojing, Hu Xueyu
Department of Orthopedics, Xijing Hospital, Air Force Medical University of PLA, Xi'an, Shaanxi Province, 710032, China.
BMC Surg. 2025 Apr 4;25(1):131. doi: 10.1186/s12893-025-02871-3.
Related studies have shown that the torsional vertebral after fused significantly increase adjacent disc stress and accelerate degeneration. This suggests that vertebral rotation (VR) may accelerate adjacent segment degeneration (ASD). To investigate: (1) the correlation between VR and radiographic adjacent segment degeneration (rASD) after the early stage of lumbar fusion (2), the incidence of rASD with different VR degrees (3), whether the incidence of rASD can be reduced by surgically reducing instrumented vertebrae (IV) rotation.
A retrospective analysis was conducted on the cases of 195 patients with lumbar degenerative disease (LDD) who were selected based on inclusion and exclusion criteria. The grade and angle of VR were measured for accurate analysis. The final follow-up evaluated the clinical improvement of the patients and the rASD. The impact of various factors on rASD was observed using univariate and multivariate logistic regression analyses. With different VR grades, Kaplan-Meier survival analysis was used to describe the incidence of rASD at various follow-up intervals.
The results indicate that preoperative adjacent vertebrae (AV) rotation (OR = 1.852, 95% CI = 1.064-3.224, P = 0.029) and IV rotation at final follow-up (OR = 2.748, 95% CI = 1.458-5.177, P = 0.002) are the independent risk factors for rASD. The results of the Kaplan-Meier analysis showed that with different VR grades, the follow-up period was different when the cumulative incidence of rASD reached 50%. The AV rotation decreased in the patients whose IV rotation decreased after the operation (P < 0.001), and the incidence of rASD was also lower (P = 0.004), especial in the fused to S1 group.
VR is a risk factor for rASD at the early stage of lumbar fusion surgery. Reducing VR during surgery can alleviate the speed of ASD and reduce the incidence of rASD in fused to S1.
相关研究表明，融合后扭转的椎体显著增加相邻椎间盘应力并加速退变。这表明椎体旋转（VR）可能加速相邻节段退变（ASD）。研究内容包括：（1）腰椎融合早期后VR与影像学相邻节段退变（rASD）之间的相关性；（2）不同VR程度下rASD的发生率；（3）通过手术减少固定椎体（IV）旋转是否可降低rASD的发生率。
对195例符合纳入和排除标准的腰椎退行性疾病（LDD）患者的病例进行回顾性分析。测量VR的分级和角度以进行准确分析。最终随访评估患者的临床改善情况和rASD。采用单因素和多因素逻辑回归分析观察各种因素对rASD的影响。对于不同的VR分级，使用Kaplan-Meier生存分析描述各随访间隔时rASD的发生率。
结果表明，术前相邻椎体（AV）旋转（OR = 1.852，95%CI = 1.064 - 3.224，P = 0.029）和最终随访时IV旋转（OR = 2.748，95%CI = 1.458 - 5.177，P = 0.002）是rASD的独立危险因素。Kaplan-Meier分析结果显示，对于不同的VR分级，rASD累积发生率达到50%时的随访期不同。术后IV旋转减少的患者AV旋转也减少（P < 0.001），且rASD的发生率也较低（P = 0.004），尤其是在融合至S1组。
VR是腰椎融合手术早期rASD的危险因素。术中减少VR可减缓ASD的进展速度，并降低融合至S1时rASD的发生率。
