腰椎后路固定融合术后邻近节段退变的中期随访研究

Adjacent segment degeneration after posterior lumbar fusion:a five-year follow-up

目的随访观察腰椎后路融合内固定术后>5年邻近节段椎间盘退行性变的程度,讨论其影响程度和因素。方法随访1999～2003年行腰椎后路融合术(L4/L5/S1、L5/S1)的患者33例,通过X线检查及部分病例的MRI检查,观察腰椎固定融合术后上方邻近节段(L3/L4、L4/S5)椎间盘退行性变的发生率和程度。结果腰椎固定融合术后邻近节段椎间盘退行性变的发生率为54.5%(18/33),但邻近节段椎间隙高度降低和日本骨科学会(Japanese Orthopae-dic Association,JOA)评分之间没有明显关联。结论腰椎融合术后邻近节段椎间盘发生退行性变的比例较高,但退变和临床疗效间并没有明显联系。

Objective To observe the degenerative changes of the discs adjacent to fixed lumber segment in patients undergoing posterior lumbar fusion 5 years ago by radiologic records,and to investigate the impact of these changes and their causes.Methods A total of 33 patients who underwent L_4/L_5 or L_4/L_5/S_1 posterior lumbar fusion during 1999 to 2003 were enrolled to investigate the degenerative changes of the discs adjacent to fixed lumber segment（L_3/L_4 or L_4/S_5） through their X-ray film and/or MRI.Intervertebral disc heights were measured before and after surgery.The patients were divided into 2 groups based on the fusion segment.Clinical status was evaluated by the recovery rate of the Japanese Orthopedic Association（JOA） score.Results Degeneration of the discs adjacent to fixed lumber segment was observed in 54.5% of subjects（18/33）.However,no significant correlation was seen between postoperative disc narrowing and JOA score.Conclusion Degeneration of the discs adjacent to fixed lumber segment is quite common in the patients after posterior lumbar fusion.But there is no evidence that the degeneration has a correlation with clinical outcome of posterior lumbar fusion.