Penta M, Sandhu A, Fraser R D
Royal Adelaide Hospital, South Australia.
Spine (Phila Pa 1976). 1995 Mar 15;20(6):743-7. doi: 10.1097/00007632-199503150-00018.
One-hundred-eight patients from a consecutive series of 125 anterior lumbar interbody fusions were invited to participate in a radiographic and magnetic resonance imaging assessment more than 10 years after the original surgery.
The aim of this study was to determine the long-term incidence of disc degeneration adjacent to an anterior interbody fusion and to determine whether this was influenced by the length of the fusion.
Biomechanical studies in human cadaver spines support the view that fusion in the lumbar spine is likely to be associated with an increased incidence of degeneration at adjacent levels, but there is little reliable information on the incidence of juxtafusion degeneration from the few long-term studies of lumbar spine fusion reported in the literature.
Eighty-seven patients agreed to take part in the study, but in six cases the magnetic resonance imaging procedure had to be abandoned. Of the 81 patients who underwent both radiographic assessment and magnetic resonance imaging scanning, preoperative discography had demonstrated a normal disc above the level of the fusion in 52. This group of patients formed the basis of this report. Each sequence of magnetic resonance imaging films was examined by one radiologist. The signal strength was assessed on T2-weighted images in the sagittal plane and disc morphology was assessed on T1- and T2-weighted sagittal and T1-weighted axial images. Fusion status was assessed on the plain films and magnetic resonance imaging.
The incidence of a normal adjacent intervertebral disc in cases of solid fusions to the sacrum was 68%. This was not influenced by the length of the fusion.
The findings of this study suggest that degeneration after an anterior lumbar interbody fusion is determined more by individual characteristics than by the fusion itself.
在连续125例前路腰椎椎间融合术患者中，邀请了108例在初次手术后10年以上参与影像学和磁共振成像评估。
本研究的目的是确定前路椎间融合术相邻节段椎间盘退变的长期发生率，并确定其是否受融合长度的影响。
人体尸体脊柱的生物力学研究支持这样一种观点，即腰椎融合术可能与相邻节段退变发生率增加有关，但文献中报道的少数腰椎融合术长期研究中，关于融合相邻节段退变发生率的可靠信息很少。
87例患者同意参与研究，但6例患者不得不放弃磁共振成像检查。在81例接受了影像学评估和磁共振成像扫描的患者中，术前椎间盘造影显示融合节段上方椎间盘正常的有52例。这组患者构成了本报告的基础。每一系列磁共振成像胶片由一名放射科医生进行检查。在矢状面T2加权图像上评估信号强度，在T1加权和T2加权矢状面图像以及T1加权轴位图像上评估椎间盘形态。在平片和磁共振成像上评估融合状态。
与骶骨进行坚固融合的病例中，相邻椎间盘正常的发生率为68%。这不受融合长度的影响。
本研究结果表明，前路腰椎椎间融合术后的退变更多地由个体特征决定，而非融合本身。
