Adjacent Segment Disease After Posterior Lumbar Interbody Fusion Based on Cases With a Minimum of 10 Years of Follow-up
Adjacent Segment Disease After Posterior Lumbar Interbody Fusion Based on Cases With a Minimum of 10 Years of Follow-up
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DOI：
10.1097/brs.0000000000000917
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发表时间：
2015-07-15
期刊：
影响因子：
3
通讯作者：
Imagama, Shiro
中科院分区：
文献类型：
--
作者：
Nakashima, Hiroaki;Kawakami, Noriaki;Imagama, Shiro
研究设计：回顾性病例对照研究。目的：研究后路腰椎椎体间融合术（PLIF）后至少10年内相邻节段退行性变（ASD）的发生率和相关危险因素。背景资料摘要：ASD是脊柱融合术后的一种有问题的后遗症。很少有长期随访研究调查了PLIF后的ASD;因此，磁共振成像（MRI）数据可用于评估术后变化与ASD是limited.Method.一百一名患者进行了回顾性入组。术后至少随访10年。对术前和术后（术后2年、5年和10年）的X线片和MRI图像进行了评价。在X线片上检查椎间盘高度、椎体滑移和椎间角度。评价MRI图像上的椎间盘退变和椎管狭窄。采用多变量logistic回归分析评估早发性影像学ASD的危险因素。Result.The退行性变化的椎间盘高度，椎体滑移，椎间角度的X线片上10年后，分别发现在12，36和17例，分别在颅侧相邻水平和3，6和11例，分别在尾侧相邻水平。术后10年MRI显示，在颅侧相邻节段分别有62例和68例椎间盘退变和椎管狭窄恶化，在尾侧相邻节段分别有25例和12例椎间盘退变和椎管狭窄恶化。10例患者（9.9%）需要再次手术，80%的翻修手术在初次手术后5年以上进行。高骨盆发病率是一个危险因素，为发展早发性影像学ASD.Conclusion.The大多数ASD的再手术进行超过5年后，最初的腰椎融合手术，虽然进展的影像学ASD开始在术后早期。盆腔发病率高是早发性房间隔缺损的危险因素。在PLIF中获得适当的腰椎前凸对于预防ASD非常重要。证据等级：4
Study Design.Retrospective case-controlled study.Objective.To investigate the incidence of adjacent segment degeneration (ASD) and the associated risk factors during a period of at least 10 years after posterior lumbar interbody fusion (PLIF).Summary of Background Data.ASD is a problematic sequelae after spinal fusion surgery. Few long-term follow-up studies have investigated ASD after PLIF; thus, magnetic resonance imaging (MRI) data available for the evaluation of postoperative changes associated with ASD are limited.Method.One hundred one patients were retrospectively enrolled. The minimum follow-up was 10 years after surgery. Preoperative and postoperative (2, 5, and 10 yr after surgery) Radiographs and MRI images were evaluated. Disc height, vertebral slip, and intervertebral angle were examined on radiographical images. Disc degeneration and spinal stenosis on MRI images were evaluated. Risk factors for developing early-onset radiographical ASD were evaluated using a multivariate logistic regression analysis.Result.The degenerative changes in disc height, vertebral slip, and intervertebral angle on radiographs 10 years after surgery were found in 12, 36, and 17 cases, respectively, at the cranial-adjacent level and in 3, 6, and 11 cases, respectively, at the caudal-adjacent level. Increased disc degeneration and spinal stenosis worsening were observed in 62 and 68 cases, respectively, at the cranial-adjacent level and in 25 and 12 cases, respectively, at the caudal-adjacent level on MRI 10 years after surgery. Ten patients (9.9%) required reoperation, and 80% of revision surgeries were performed more than 5 years after the initial surgery. High pelvic incidence was a risk factor for developing early-onset radiographical ASD.Conclusion.The majority of the reoperations for ASD were performed more than 5 years after the initial lumbar fusion surgery, although the progression of radiographical ASD began in the early postoperative period. A high degree of pelvic incidence was a risk factor for developing early-onset radiographical ASD. Obtaining appropriate lumbar lordosis in PLIF is important for preventing ASD.Level of Evidence: 4