The Fate of Facet Joint and Adjacent Level Disc Degeneration Following Total Lumbar Disc Replacement A Prospective Clinical, X-Ray, and Magnetic Resonance Imaging Investigation
The Fate of Facet Joint and Adjacent Level Disc Degeneration Following Total Lumbar Disc Replacement A Prospective Clinical, X-Ray, and Magnetic Resonance Imaging Investigation
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DOI：
10.1097/brs.0b013e3181d6f878
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发表时间：
2010-10-01
期刊：
影响因子：
3
通讯作者：
Mayer, Michael H.
中科院分区：
文献类型：
--
作者：
Siepe, Christoph J.;Zelenkov, Pjotr;Mayer, Michael H.
研究设计。使用 ProDisc II（宾夕法尼亚州保利市 Synthes）进行全腰椎间盘置换 (TDR) 后的前瞻性临床、X 射线和磁共振成像研究。目的。检查 TDR 后邻近节段退变 (ALD)、小关节退变 (FJD) 的进展以及相关危险因素。背景数据摘要。在相当多的患者中，融合手术与邻近节段发病和小关节病变有关。 TDR 是否可以降低这些负面副作用的发生率尚未确定。方法。临床结果评分视觉模拟量表 (VAS)、Oswestry 残疾指数 (ODI) 和患者满意度是在 ProDisc II 正在进行的前瞻性研究的框架内获得的。根据多个屈曲/伸展 X 射线图像，为每位患者在整个术后期间建立了平均指数级 ROM。由 2 名独立放射科医生根据术前和术后磁共振图像评估 ALD 和 FJD 的进展。结果。本研究纳入了 93 名患者的结果，平均随访时间为 53.4 个月（范围：24.1-98.7 个月）。总体结果显示，与术前 VAS 和 ODI 水平相比，有显着改善（P < 0.0001）。ALD 发生率为 10.2%（n = 11/108 水平）。退行性改变较轻微，发生在术后较晚（平均 65.2 个月；范围 37.9-85.6 个月）。指数级ROM与ALD的发生之间没有显着相关性（P > 0.05）。在所有小关节中，20.0%观察到FJD进展（n = 44/220）。与腰骶交界处以上水平相比，TDR 后腰骶交界处 FJD 的发生率明显更高 (P < 0.02)，并且在指数水平比在非指数水平更常见 (P < 0.001)。退行性变化与术后结果参数 VAS 和 ODI 的负面影响相关 (P < 0.03)，这些参数在术后早期就已检测到。与其余队列相比，FJD 进展的患者术后平均 ROM 显着较低 (P < 0.0001)。结论。事实证明，TDR 对于相邻层椎间盘的保存具有有益的作用。退行性变化轻微，发生在术后较晚，并且没有对术后临床结果产生负面影响。指数级 ROM 与 ALD 的发生之间没有显着相关性（P > 0.05）。然而，在相当多的患者中，TDR 与指数级 FJD 的进展相关，特别是在腰骶交界处。较低的节段活动度和较差的临床结果表明，特定的患者群体可能主要受到影响，其中 TDR 显示与索引节段的生物力学的兼容性较差。
Study Design. Prospective clinical, x-ray, and magnetic resonance imaging investigation following total lumbar disc replacement (TDR) with ProDisc II (Synthes, Paoli, PA).Objective. To examine the progression of adjacent level degeneration (ALD), facet joint degeneration (FJD) as well as associated risk factors following TDR.Summary of Background Data. Fusion procedures have been associated with adjacent level morbidities and facet joint pathologies in a considerable number of patients. Whether the incidence of these negative side effects can be reduced with TDR remains unestablished.Methods. Clinical outcome scores Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) and patient satisfaction rates were acquired within the framework of an ongoing prospective study with ProDisc II. The mean index-level ROM was established for every patient over the entire postoperative period from multiple flexion/extension x-ray images. The progression of ALD and FJD was evaluated from pre- and postoperative magnetic resonance images by 2 independent radiologists.Results. Results from 93 patients with an average follow-up of 53.4 months (range, 24.1-98.7 months) were included in this study. The overall results revealed a significant improvement from preoperative VAS and ODI levels (P < 0.0001).The incidence of ALD was 10.2% (n = 11/108 levels). The degenerative changes were mild and occurred late after surgery (mean, 65.2 months; range, 37.9-85.6 months). There was no significant correlation between index-level ROM and the occurrence of ALD (P > 0.05).Progression of FJD was observed in 20.0% of all facet joints (n = 44/220). FJD occurred significantly more often following TDR at the lumbosacral junction in comparison to the level above the lumbosacral junction (P < 0.02) and was observed more frequently at index-levels than at nonindex levels (P < 0.001).The degenerative changes were associated with a negative influence on postoperative outcome parameters VAS and ODI (P < 0.03) that were already detected early after surgery. The mean postoperative ROM was significantly lower in patients with progression of FJD in comparison to the remaining cohort (P < 0.0001).Conclusion. TDR proved to have a beneficial effect with respect to adjacent level disc preservation. The degenerative changes were mild, occurred late after surgery and did not reveal a negative effect on postoperative clinical outcome. There was no significant correlation between index-level ROM and the occurrence of ALD (P > 0.05).TDR was, however, associated with a progression of index-level FJD in a considerable number of patients, particularly at the lumbosacral junction. Lower segmental mobility and less favorable clinical results point to the fact that a particular cohort of patients may predominantly be affected in which TDR shows inferior compatibility with the index-segment's biomechanics.