Radiographic evaluation of segmental motion of scoliotic wedging segment in degenerative lumbar scoliosis.
Radiographic evaluation of segmental motion of scoliotic wedging segment in degenerative lumbar scoliosis.
复制标题
退变性腰椎侧凸脊柱侧弯楔形节段运动的放射学评估。
DOI：
10.1097/bsd.0b013e31824a4129
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发表时间：
2013
期刊：
影响因子：
--
通讯作者：
Nakamura H.
中科院分区：
文献类型：
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作者：
Yasuda H;Matsumura A;Terai H;Toyoda H;Suzuki A;Dozono S;Nakamura H.
研究设计：横断面研究。目的：应用动态影像评价退行性腰椎侧凸（DLS）楔入节段的不稳定性及骨赘形成对节段运动的影响。背景资料总结：评估DLS患者的节段不稳定性对于脊柱手术决定“融合或不融合”至关重要。一些先前的研究显示了DLS中节段性不稳定的影像学数据。然而，对于DLS中楔形节段的运动却知之甚少。方法：选取101例主诉腰椎管狭窄（LCS）所致神经源性跛行患者，根据其冠状椎管畸形分为两组；Cobb角小于10度（DLS组）或小于10度（LCS组）。在正位片上测量以下参数：侧向平移，骨赘形成程度和侧向弯曲片的活动范围（ROM）。在计算机断层扫描图像上测量关节突关节间隙差异。比较DLS组85个楔形节段（bb0 ~ 5度）和LCS组150个非楔形节段的影像学参数。结果：DLS组平均侧移量显著高于对照组（各水平P< 0.01）。DLS组平均关节间隙差异显著大于L2/3和L3/4 (P< 0.01), L4/5 （P = 0.01）。在相同程度骨赘形成的DLS组，ROM明显增加。DLS组骨赘形成程度与ROM呈负相关（r2 = 0.5696）。结论：本研究表明，DLS的楔形节段比LCS的非楔形节段运动更大。然而，骨赘的形成为DLS中的楔形节段提供了再稳定，这表明骨赘形成的评估是DLS手术决策的重要因素。
Study Design:A cross-sectional study.Objective:To evaluate the segmental instability of wedging segments using dynamic films and the impact of osteophyte formation on segmental motion in degenerative lumbar scoliosis (DLS).Summary of Background Data:Evaluation of segmental instability in DLS is essential for spinal surgery to make the decision “fusion or not fusion.” Some previous studies have shown radiographic data regarding segmental instability in DLS. However, little is known about segmental motion of wedging segments in DLS.Methods:A total of 101 patients complaining of neurogenic claudication owing to lumbar spinal canal stenosis (LCS) were enrolled and divided into 2 groups based on their coronal spinal deformity; Cobb angle of> 10 degree (DLS group) or< 10 degree (LCS group). The following parameters were measured on anteroposterior films: lateral translation, degree of osteophyte formation, and range of motion (ROM) in lateral bending films. The facet joint space discrepancy was measured on computed tomography images. The radiographic parameters were compared between 85 wedging segments (> 5 degrees) in DLS group and 150 nonwedging segments in LCS group.Results:Mean lateral translation was significantly greater in the DLS group (P< 0.01 for each level). Average joint space discrepancy was significantly greater in the DLS group (P< 0.01 at L2/3 and L3/4, P= 0.01 at L4/5). ROM was significantly greater in the DLS group with the same degree osteophyte formation. Degree of osteophyte formation was inversely correlated with ROM in the DLS group (R 2= 0.5696).Conclusions:The present study indicated that wedging segments in DLS had greater motion than nonwedging segments in LCS. However, the osteophyte formation provided restabilization for the wedging segments in DLS, suggesting that evaluation of osteophyte formation is an important factor in surgical decision making for DLS.