腰椎后路单节段融合单侧置钉与双侧置钉远期相邻节段退变对比分析

Comparison of adjacent segment degeneration after successful posterolateral fusion with unilateral or bilateral pedicle screw instrumentation

目的比较腰融合术后单节段融合单侧置钉与双侧置钉远期相邻节段退变的差别。方法回顾性研究2002-2006年沈阳军区总医院收治的197例单节段行腰椎融合术的腰椎管狭窄症或腰椎滑脱症的患者。术后影像学评估主要通过影像学检查评估患者融合节段的头侧主要相邻节段、尾侧相邻节段及头侧次要相邻节段的运动范围,临床症状评估主要通过功能障碍指数(ODI)评分和改善率。结果 194例患者中有147例接受5年以上的影像学检查及临床症状随访。59例单侧椎弓根置钉患者中33例发生相邻节段退变(头侧相邻节段和尾侧相邻节段),发生率为55.9%,88例双侧椎弓根置钉患者64例发生相邻节段退变(头侧相邻节段和尾侧相邻节段),发生率为72.7%,两组间比较差异无统计学意义(P=0.35),但两组间头侧次级相邻节段退变发生率差异有统计学意义(P=0.04),两组间通过功能障碍指数评定得出的临床症状比较,差异有统计学意义(P=0.04),尤其是合并相邻节段退变的患者临床症状差别更明显。结论通过5年以上的随访发现,单侧椎弓根置钉的腰椎融合术影像学相邻节段尤其是头侧次级相邻节段退变的发生率较低,且由此引起的临床症状也较双侧椎弓根置钉组较轻。

Objective To compare adjacent segment degeneration（ASD） differences after successful posterolateral fusion u- sing either unilateral or bilateral pedicle s^crew instrumentation. Methods A total of 194 consecutive patients with lumbar spinal stenosis and/or spondylolisthesis were included in our study. Radiologic ASD was evaluated at three motion seg- ments： cephalad adjacent segment （first cephalad adjacent segment）,one eephalad to cephalad adjacent segment （second cephalad adjacent segment） , and caudal adjacent segment. Clinical outcomes were compared by ODI scores and revision rates. Results Totally, 147 of 194 （75.8%） patients were available for at least 5 years of radiologic and clinical follow - up. Adjacent segment degeneration （in first cephalad or caudal adjacent segment） was noted in 55.9% （33 of 59 patients） of the unilateral group and 72.7% （64 of 88 patients） of the bilateral group （P = 0.35）. The occurrence of ASD in each first cephalad and caudal adjacent segment was not significantly different between groups but that in second cephalad adja- cent segment was significantly different between groups （P = 0.04 ）. Clinical outcomes according to ODI showed significant difference between groups, especially when ODI scores were compared in patients with ASD （ P = 0.04）. Conclusion In a minimum 5 - year follow - up retrospective study of posterolateral fusion, unilateral pedicle screw instrumentation showed a lower rate of radiologic ASD in second cephalad adjacent segment, and better clinical symptoms by ODI.