A Comparison of Radiographic Findings in Fusion and Nonfusion Patients Ten or More Years Following Lumbar Disc Surgery
A Comparison of Radiographic Findings in Fusion and Nonfusion Patients Ten or More Years Following Lumbar Disc Surgery
复制标题
腰椎间盘手术后十年或十年以上融合与非融合患者的影像学结果比较
作者：
J. Frymoyer;E. Hanley;J. Howe;D. Kuhlmann;R. Matteri
96例接受椎间盘切除和中线脊柱融合术的患者和36例接受单纯椎间盘切除术的患者在术后10年或更长时间进行了脊柱X线片检查。在融合患者中，尤其是男性劳动者，最常见的是L2-3和L3-4节段。在脊柱未融合的患者中，尤其是女性，L4-5节段更常见牵引性骨刺伴节段性过度活动。非融合患者的腰椎屈曲-伸展总活动度大于融合患者，但融合患者的L1 - 3活动度更大，表明腰椎活动度代偿性增加。在非融合患者中，手术节段的节段活动度在临床结果良好和较差的患者中相似。椎间隙狭窄在手术节段很常见，但与临床结果不一致。26%的融合患者出现假关节，但无临床意义。尽管腰椎间盘手术后会出现复杂的影像学变化，无论是否失败，但可以得出结论，平面X光片对于确定术后疼痛的来源几乎没有帮助。唯一的例外是获得性椎弓峡部裂，在该组融合患者中发现了2.5%，并且明显与不良临床结局相关。腰椎融合以上节段的症状性退行性椎间盘疾病似乎是一个罕见的临床问题。
Ninety-six patients who had undergone disc excision and midline spinal fusion and 36 patients who had had simple disc excision had spinal radiographs made 10 or more years postoperatively. Claw spurs were found most commonly at the L2-3 and L3-4 levels in fusion patients, particularly male laborers. Traction spurs with segmental hypermobility were found more commonly at the L4-5 level in patients whose spines were not fused, particularly women. Total lumbar flexion-extension was greater in nonfusion than in fusion patients, but the L1 - 3 mobility was greater in those who had undergone fusion, suggesting a compensatory increase in the range of lumbar motion. Segmental mobility at levels of surgery in nonfusion patients was similar in those with good and those with poor clinical results. Disc space narrowing was common at levels of operation, but did not correspond to the clinical result. Pseudarthrosis was demonstrated in 26% of fusion patients, but was of no clinical significance. Although complex radiographic changes follow lumbar disc surgery, with or without failure, it is concluded that the plane radiograph is of little aid in determining the source of postoperative pain. The sole exception is that of acquired spondylolysis, which was found in 2.5% of this group of fusion patients, and was clearly associated with a poor clinical outcome. Symptomatic degenerative disc disease at levels above lumbar spinal fusions appears to be an uncommon clinical problem.