Correlation between sagittal plane changes and adjacent segment degeneration following lumbar spine fusion
Correlation between sagittal plane changes and adjacent segment degeneration following lumbar spine fusion
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DOI：
10.1007/s005860000239
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发表时间：
2001-08-01
影响因子：
2.8
通讯作者：
Chopin, D
中科院分区：
文献类型：
--
作者：
Kumar, MN;Baklanov, A;Chopin, D
腰椎融合术后临近节段退变仍然是一个公认的问题，但对其发生的因素了解不足。本研究的目的是分析腰椎矢状面形态异常与邻近节段退变的关系。回顾性分析了83例因退行性椎间盘病变而行腰椎融合术的患者。伴有椎体滑脱和退行性脊柱侧凸的患者不包括在本研究中。平均随访时间为5年。对结果进行分析，以确定矢状面形态异常与术后邻近节段退变之间的关系。83例患者中有31例（36.1%）表现为邻近节段退变。术后立即x线片上C7垂直线和骶椎倾角正常的患者与其中一项或两项参数异常的患者相比，相邻水平改变的发生率最低。差异有统计学意义（P < 0.02）。男性和女性患者相邻节段退变的发生率-单纯后路融合术与后外侧和后路椎间联合融合术之间无统计学差异；在向下延伸到骶骨和在骶骨附近停止的融合之间。结论：骶骨倾斜的正常程度是降低相邻节段退变发生率的重要参数。后滑脱是最常见的相邻节段改变类型。术后矢状面异常的患者最好随访至少5年，以发现邻近水平的变化。
Adjacent segment degeneration following lumbar spine fusion remains a widely acknowledged problem, but there is insufficient knowledge regarding the factors that contribute to its occurrence. The aim of this study is to analyse the relationship between abnormal sagittal plane configuration of the lumbar spine and the development of adjacent segment degeneration. Eighty-three consecutive patients who underwent lumbar fusion for degenerative disc disease were reviewed retrospectively. Patients with spondylolytic spondylolisthesis and degenerative scoliosis were not included in this study. Mean follow-up period was 5 years. Results were analysed to determine the association between abnormal sagittal configuration and post operative adjacent segment degeneration. Thirty-one out of 83 patients (36.1%) showed radiographic evidence of adjacent segment degeneration. Patients with normal C7 plumb line and normal sacral inclination in the immediate post operative radiographs had the lowest incidence of adjacent level change compared with patients who had abnormality in one or both of these parameters. The difference was statistically significant (P < 0.02). There was no statistically significant difference in the incidence of adjacent level degeneration between male and female patients-between posterior fusion alone and combined posterolateral and posterior interbody fusions; and between fusions extending down to the sacrum and fusions stopping short of the sacrum. It was concluded was that normality of sacral inclination is an important parameter for minimizing the incidence of adjacent level degeneration. Retrolisthesis was the most common type of adjacent segment change. Patients with post operative sagittal plane abnormalities should preferably be followed-up for at least 5 years to detect adjacent level changes.