Clinical efficacy and radiographic K-rod stabilization for the treatment of multilevel degenerative lumbar spinal stenosis
Clinical efficacy and radiographic K-rod stabilization for the treatment of multilevel degenerative lumbar spinal stenosis
复制标题
K-rod稳定治疗多节段退变性腰椎管狭窄症的临床疗效及影像学检查
DOI：
10.1186/s12891-020-03466-0
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发表时间：
2020-07-06
影响因子：
2.3
通讯作者：
Lin, Hongsheng
中科院分区：
文献类型：
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作者：
Fu, Chaohua;Chen, Tianjun;Lin, Hongsheng
本研究对多节段退行性腰椎管狭窄症患者采用K棒和刚性系统治疗进行了对比研究。方法自2013年3月至2017年3月，对40例多节段退行性腰椎管狭窄症患者采用K棒(n= 25)和刚性系统(n= 15)进行手术治疗。平均随访期29.1月( )。评估JOA、ODI、VAS和改良Macnab。放射学评估包括腰椎前凸角、ISR值、手术和近端邻近活动度。结果两组患者术后JOA、ODI、VAS均有明显变化，与手术前比较差异有统计学意义。然而，在两组患者的最后一次随访中，腰椎前凸度显著降低。末次随访时，近侧邻近节段的活动度增加，而K-Rod组固定节段的活动度在末次随访时明显低于术前。在两组患者中，近端相邻节段的ISR均有下降，其中最明显的是刚性节段。K-Rod组非融合固定节段的ISR在术后和末次随访时均有增加。根据改良的Pfirmann分级和UCLA系统，动态K-Rod组的相邻节段退变程度明显高于K-Rod组。结论与刚性系统治疗MDLSS相比，动态K-Rod内固定治疗MDLSS获得了更好的影像效果，改善了稳定节段的活动度，最大限度地减少了对近侧相邻节段的影响。
BackgroundThis study compares the use of radiographic K-Rod dynamic stabilization to the rigid system for the treatment of multisegmental degenerative lumbar spinal stenosis (MDLSS).MethodsA total of 40 patients with MDLSS who underwent surgical treatment using the K-Rod (n= 25) and rigid systems (n= 15) from March 2013 to March 2017 were assessed. The mean follow-up period was 29.1 months. JOA, ODI, VAS and modified Macnab were assessed. Radiographic evaluations included lumbar lordosis angle, ISR value, operative and proximal adjacent ROM. Changes in intervertebral disc signal were classified according to Pfirrmann grade and UCLA system.ResultsJOA, ODI and VAS changed significantly after the operation to comparable levels between the groups. However, the lumbar lordosis significantly decreased at final follow-up between both groups. The ROM of the proximal adjacent segment increased at final follow-up, but the number of fixed segment ROMs in the K-Rod group were significantly lower at the final follow-up than observed prior to the operation. In both groups, the ISR of the proximal adjacent segment decreased, most notably in the rigid group. The ISR of the non-fusion fixed segments in the K-Rod group increased post-operation and during final follow-up. The levels of adjacent segment degeneration were higher in the rigid group vs. the K-Rod group according to modified Pfirrmann grading and the UCLA system.ConclusionsCompared with the rigid system for treatment of MDLSS, dynamic K-Rod stabilization achieves improved radiographic outcomes and improves the mobility of the stabilized segments, minimizing the influence on the proximal adjacent segment.