Pheasant Michael S, Parry Matthew W, Girgis Mina, Tang Alex, Chen Tan
Geisinger Musculoskeletal Institute, Danville, PA 17822, USA.
Division of Orthopedic Spine Surgery, Geisinger Musculoskeletal Institute, Danville, PA 17822, USA.
J Clin Med. 2025 May 11;14(10):3337. doi: 10.3390/jcm14103337.
The lumbar degenerative cascade is a pathological process that affects most of the aging adult population and has significant negative economic consequences. Lumbar fusion surgery remains a mainstay of treatment for refractory degenerative disease but carries significant long-term consequences. More recently, lumbar arthroplasty and motion-sparing technology has become an increasingly popular alternative surgical option in carefully indicated patients. Arthroplasty technology carries the theoretical benefits of spinal segment motion preservation and decreased degeneration of adjacent segments as compared to traditional fusion procedures. This article will review the lumbar degenerative cascade and its related anatomic considerations, current management strategies and the challenges surrounding lumbar spinal fusion, including adjacent segment disease. This article will also review the theoretical benefits of lumbar arthroplasty and motion preservation. Furthermore, this paper will highlight the current state of lumbar arthroplasty, including current concepts of implant design, limitations, outcomes and ongoing development. It will review the development and current state of artificial disk arthroplasty, total joint arthroplasty and posterior column motion-preserving implants, including flexible rods and facet joint replacement.
腰椎退变级联反应是一种影响大多数老年人群的病理过程，会产生重大的负面经济后果。腰椎融合手术仍然是难治性退行性疾病的主要治疗方法，但会带来重大的长期后果。最近，腰椎关节置换术和保留运动功能的技术在经过仔细筛选的患者中已成为越来越受欢迎的替代手术选择。与传统融合手术相比，关节置换技术具有保留脊柱节段运动和减少相邻节段退变的理论优势。本文将综述腰椎退变级联反应及其相关的解剖学考量、当前的管理策略以及围绕腰椎融合术的挑战，包括相邻节段疾病。本文还将综述腰椎关节置换术和保留运动功能的理论优势。此外，本文将重点介绍腰椎关节置换术的现状，包括植入物设计的当前概念、局限性、结果和正在进行的发展。它将回顾人工椎间盘置换术、全关节置换术和后柱保留运动功能植入物的发展和现状，包括柔性棒和小关节置换。
