脊柱融合术后相邻节段退变的病因及其影响因素

Etiology and its effective factors of adjacent segment degeneration after spinal fusion

近年来,随着脊柱融合手术的急剧增加和内固定器械的广泛应用,邻近节段退变性疾病逐渐引起人们的关注,依据临床症状判定其发生率约为5.2%～18.5%,其最常见的病理变化是椎间盘退变。导致相邻节段退变的原因包括邻近节段关节突负荷增加、活动度增大和邻近间盘内压增高,而邻近节段退变的影响因素:脊柱内固定、融合节段、矢状面上的曲度、邻近节段椎间盘退变及患者自身的特点。关于邻近节段退变的治疗,若融合术后患者的症状与邻近节段退变的病理相符时,外科干预强调充分减压和扩大融合节段,但是结果并不确切。

Adjacent segment degeneration （ASD）was popular with spinal fusion operation increasing and broad application of instrumentation ,the incident rate of symptomatic ASD was from 5.2% to 18.5%. So etiology and its effective factors of adjacent segment degeneration after spinal fusion were reviewed. Its common pathological change was disc degeneration. Increased intradiscal pressure,increased facet loading and increased mobility were important reasons that leaded to adjacent segment degeneration after spinal fusion. Its effective factors included instrumentation application, fusion segment, sagittal malalignment, adjacent disc degeneration and patient characteristics. Adequate decompression and extension of the fusion could be performed if the symptoms were adjustable with the pathology of adjacent segment degeneration ,but outcomes were not exact.