Adjacent segment disease following lumbar/thoracolumbar fusion with pedicle screw instrumentation - A minimum 5-year follow-up
Adjacent segment disease following lumbar/thoracolumbar fusion with pedicle screw instrumentation - A minimum 5-year follow-up
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DOI：
10.1097/brs.0b013e31814b2d8e
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发表时间：
2007-09-15
期刊：
影响因子：
3
通讯作者：
Baldus, Christy
中科院分区：
文献类型：
--
作者：
Cheh, Gene;Bridwell, Keith H.;Baldus, Christy
研究设计.回顾性影像学结局分析。我们有三个假设：1）较长的融合; 2）更近端的内固定椎体，3）环周融合与单纯后路融合相比，会增加相邻节段疾病（ASD）的可能性。分析ASD患者的危险因素、患病率和表现的文献多种多样，没有明确的共识。共纳入了188例至少随访5年的患者，这些患者接受了腰椎/胸腰椎融合术和椎弓根螺钉内固定术治疗退行性疾病。影像学ASD定义为：1）脊椎前移> 4 mm，2）节段性后凸> 10，3）椎间隙完全塌陷，或4）Weiner分级恶化2级以上。临床ASD定义为：1）症状性椎管狭窄，2）顽固性背痛，或3）继发性矢状面或冠状面不平衡。42.6%（80/188）的患者发生放射学ASD。最终随访时，影像学ASD患者的奥斯韦斯特里评分（20.3 vs. 12.5; P = 0.001）低于无ASD患者。30.3%（57/188）的患者发生临床ASD。临床ASD表现为椎管狭窄（n = 47），不稳定型背痛（n = 5）和矢状或冠状失衡（n = 5）。手术年龄超过50岁和融合长度是腰椎ASD发展的重要风险因素。与L4和L5相比，L1-L3近端融合增加了ASD的风险。环周融合与后路融合在ASD的发展中不是一个重要因素。50岁以上患者发生临床ASD的风险高于50岁或以下患者。融合长度是腰椎ASD发展的一个重要风险因素。与L4和L5相比，L1-L3的融合增加了ASD的风险。与后外侧融合相反，环周融合不是ASD发展的统计学显著风险因素。
Study Design. Retrospective radiographic outcomes analysis.Objective. We had 3 hypotheses: 1) a longer fusion; 2) a more proximal instrumented vertebra, and 3) circumferential fusion versus posterior-only fusion would increase the likelihood of adjacent segment disease (ASD).Summary of Background Data. The literature analyzing risk factors, prevalence, and presentation of patients with ASD is varied and without clear consensus.Methods. A total of 188 patients with minimum 5-year follow-up who had lumbar/thoracolumbar fusion with pedicle screw instrumentation for degenerative disorders were included. Radiographic ASD was defined by: 1) development of spondylolisthesis > 4 mm, 2) segmental kyphosis > 10, 3) complete collapse of disc space, or 4) more than 2 grades worsening of Weiner classification. Clinical ASD was defined as 1) symptomatic spinal stenosis, 2) intractable back pain, or 3) subsequent sagittal or coronal imbalance.Results. Radiographic ASD occurred in 42.6% (80 of 188) of patients. Patients with radiographic ASD had worse Oswestry scores (20.3 vs. 12.5; P = 0.001) at ultimate follow-up than those without ASD. Clinical ASD developed in 30.3% (57 of 188) of patients. Clinical ASD manifested as spinal stenosis (n = 47), instability-type back pain ( n = 5), and sagittal or coronal imbalance (n = 5). Age at surgery over 50 years and length of fusion were significant risk factors for the development of ASD in the lumbar spine. Fusion to L1-L3 proximally increased the risk of ASD when compared with L4 and L5. Circumferential fusion versus posterior fusion was not a significant factor in the development of ASD.Conclusion. Patients over the age of 50 were at higher risk of developing clinical ASD than those 50 years old or younger. Length of fusion was a significant risk factor in the development of ASD in the lumbar spine. Fusion up to L1-L3 increased the risk of ASD when compared with L4 and L5. Circumferential fusion, as opposed to posterolateral fusion, was not a statistically significant risk factor for the development of ASD.