Risk Factors of Adjacent Segment Disease Requiring Surgery After Lumbar Spinal Fusion
Risk Factors of Adjacent Segment Disease Requiring Surgery After Lumbar Spinal Fusion
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DOI：
10.1097/brs.0000000000000164
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发表时间：
2014-03-01
期刊：
影响因子：
3
通讯作者：
Shin, Byung-Joon
中科院分区：
文献类型：
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作者：
Lee, Jae Chul;Kim, Yongdai;Shin, Byung-Joon
研究设计。回顾性研究。目的：确定既往行腰椎退行性疾病脊柱融合术的患者中需要手术的邻近节段疾病（ASD）的发生率和危险因素，并根据各种危险因素比较邻近节段的生存率，包括比较融合方法：后路腰椎椎间融合术（PLIF）与后侧融合术（PLF）。背景资料摘要。腰椎融合术后的主要问题之一是相邻节段疾病的发展。生物力学上，PLIF比PLF更僵硬，因此，PLIF患者被怀疑比PLF患者有更高的ASD发病率。已经有很多研究分析了ASD的危险因素，但我们还没有看到任何研究比较PLIF和PLF在需要手术的ASD发生率方面的差异。我们确定了连续490例接受3节段或更少节段腰椎融合术治疗腰椎退行性疾病的患者。指数手术时平均年龄53岁，平均随访51个月（12 ~ 236个月）。PLF和PLIF治疗的患者分别为103例和387例。采用Kaplan-Meier法计算ASD翻修手术的发生率和患病率。对于危险因素分析，我们使用log-rank检验和Cox回归分析，包括融合方法、性别、年龄、融合节段数量以及在指数融合附近是否有椎板切除术。在腰椎融合术后，23名患者（4.7%）接受了额外的ASD手术。Kaplan-Meier分析预测，指数手术后5年和10年，94.2%的患者相邻节段无病生存率分别为94.2%和89.6%。在危险因素分析中，PLIF与需要手术的ASD发生率比PLF高3.4倍（P = 0.037）。指数手术时年龄大于60岁的患者接受翻修手术的可能性是年龄小于60岁患者的2.5倍（P = 0.038）。性别、术前诊断、融合节段数目、是否同时行椎板切除术对相邻节段的生存率无显著性差异。据预测，10%的患者在腰椎融合术后10年内将接受额外的手术治疗ASD。在本研究中，PLIF的ASD发病率高于PLF。患者年龄大于60岁是另一个独立的危险因素。外科医生在制定腰椎融合手术计划时应仔细考虑这些因素。
Study Design. A retrospective study.Objective. To determine the incidence and risk factors of adjacent segment disease (ASD) requiring surgery among patients previously treated with spinal fusion for degenerative lumbar disease and to compare the survivorship of adjacent segment according to various risk factors including comparison of fusion methods: posterior lumbar interbody fusion (PLIF) versus posterolateral fusion (PLF).Summary of Background Data. One of the major issues after lumbar spinal fusion is the development of adjacent segment disease. Biomechanically, PLIF has been reported to be more rigid than PLF, and therefore, patients who undergo PLIF are suspected to experience a higher incidence of ASD than those who underwent PLF. There have been many studies analyzing the risk factors of ASD, but we are not aware of any study comparing PLIF with PLF in incidence of ASD requiring surgery.Methods. A consecutive series of 490 patients who had undergone lumbar spinal fusion of 3 or fewer segments to treat degenerative lumbar disease was identified. The mean age at index operation was 53 years, and the mean follow-up period was 51 months (12-236 mo). The number of patients treated by PLF and PLIF were 103 and 387, respectively. The incidence and prevalence of revision surgery for ASD were calculated by Kaplan-Meier method. For risk factor analysis, we used log-rank test and Cox regression analysis with fusion methods, sex, age, number of fused segments, and presence of laminectomy adjacent to index fusion.Results. After index spinal fusion, 23 patients (4.7%) had undergone additional surgery for ASD. Kaplan-Meier analysis predicted a disease-free survival rate of adjacent segments in 94.2% of patients at 5 years and 89.6% at 10 years after the index operation. In the analysis of risk factors, PLIF was associated with 3.4 times higher incidence of ASD requiring surgery than PLF (P = 0.037). Patients older than 60 years at the time of index operation were 2.5 times more likely to undergo revision operation than those younger than 60 years (P = 0.038). There were no significant differences in survival rates of the adjacent segment according to sex, preoperative diagnosis, number of fused segments, and concomitant laminectomy to adjacent segment.Conclusion. It was predicted that 10% of patients would undergo additional surgery for treating ASD within 10 years after index lumbar fusion. In this study, PLIF showed higher incidence of ASD than did PLF. Patient age greater than 60 years was another independent risk factor. Surgeons should carefully consider these factors at the time of surgical planning of lumbar fusion.