Schlegel J D, Smith J A, Schleusener R L
Department of Orthopedic Surgery, University of Utah, School of Medicine, Salt Lake City, USA.
Spine (Phila Pa 1976). 1996 Apr 15;21(8):970-81. doi: 10.1097/00007632-199604150-00013.
Fifty-eight patients came to two spinal surgeons with abnormalities adjacent to a previously fused thoracic or lumbosacral segment after they had been asymptomatic for more than 2 years. Radiographs, outcome analysis, analog pain evaluation, patient demographics, and medical indices were analyzed to evaluate risk factors for adjacent segment abnormality.
Risk factors for adjacent segment breakdown and pathophysiology of adjacent segment breakdown were analyzed in this longitudinal study.
Fifty-eight patients underwent a thoracolumbar, lumbar, or lumbosacral fusion with an average symptom-free period of 13.1 years before presentation with severe symptomatology necessitating further surgery at the adjacent segment.
Fifty-eight patients with adjacent segment abnormality were analyzed by outcome assessment questionnaire, pain analog evaluation, radiographic studies, demographic factors, and sequential follow-up evaluation. Thirty-seven of these patients have been followed for more than 2 years after their adjacent segment surgery.
Fifty-eight patients developed spinal stenosis, disc herniation, or instability at a segment adjacent to a previously asymptomatic fusion that was done an average of 13.1 years earlier. Segments adjacent to the adjacent segment itself were as likely to breakdown (58%). Thirty-seven patients were followed for more than 2 years, having outcomes defined as good or excellent in 70.3%. Seven of the 37 patients required an additional surgical procedure. Sagittal and coronal imbalances appeared to play a role in breakdown, although statistical significance was not evident.
This represents the largest series of adjacent segment breakdowns reported in the literature. The segment adjacent to the adjacent segment was almost as likely to breakdown. Sagittal and coronal alignment appeared to play a role in adjacent abnormality. Good outcomes are evident in 70% of cases.
58例患者在先前融合的胸段或腰骶段相邻部位出现异常，这些患者在无症状超过2年后前来就诊于两位脊柱外科医生。对X线片、结果分析、视觉模拟疼痛评估、患者人口统计学资料及医学指标进行分析，以评估相邻节段异常的危险因素。
在这项纵向研究中分析相邻节段退变的危险因素及相邻节段退变的病理生理学。
58例患者接受了胸腰段、腰椎或腰骶段融合术，在出现严重症状需要对相邻节段进行进一步手术之前，平均无症状期为13.1年。
通过结果评估问卷、视觉模拟疼痛评估、影像学研究、人口统计学因素及连续随访评估对58例相邻节段异常患者进行分析。其中37例患者在相邻节段手术后随访超过2年。
58例患者在先前平均13.1年前无症状的融合节段相邻部位出现了椎管狭窄、椎间盘突出或不稳定。相邻节段本身相邻的节段发生退变的可能性相同（58%）。37例患者随访超过2年，70.3%的患者结果为良好或优秀。37例患者中有7例需要再次手术。矢状面和冠状面失衡似乎在退变中起作用，尽管统计学意义不明显。
这是文献报道中最大系列的相邻节段退变病例。相邻节段本身相邻的节段几乎同样可能发生退变。矢状面和冠状面排列似乎在相邻节段异常中起作用。70%的病例结果良好。
