L_(4-5)融合术后邻近节段退变的回顾性分析

A retrospective study on adjacent segment degeneration secondary to L_(4-5) fusion

[目的]探讨L_(4-5)融合术后邻近节段退变的发生率及风险因素。[方法]回顾性分析了十年间本院因腰椎退变经PLIF或TLIF手术行L_(4-5)融合的患者资料(随访时间≥1年)。按手术方式不同分为后路腰椎融合术(PLIF)组和经椎间孔入路腰椎融合术(TLIF)组。邻近节段退变(ASD)在本文中指的是L_(4-5)上下邻近节段发生的有临床症状或影像学表现,且需要接受再次手术治疗的患者。[结果]所有接受L_(4-5)融合的355例病例中,需要再手术的ASD共42例54节段,其中L_(1-2)3例(5%),L_(2-3)13例(24%),L_(3-4)29例(54%),L_5S_1 9例(17%),整体ASD发生率为11.8%。L_(3-4)节段最易发生ASD(P<0.001)。虽然PLIF组的ASD发生率高于TLIF组,但两种术式间的差异无统计学意义(14%vs 9.5%,P=0.189)。PLIF组与TLIF组的头侧ASD发生率均显著高于尾侧(P<0.001)。根据Kaplan-Meier生存曲线分析,PLIF和TLIF手术组ASD的发病时间差异无统计学意义(P=0.1559)。[结论]355例患者中,ASD发病率为12%,平均发病时间为术后2年。L_(3-4)节段是L_(4-5)后路融合术后ASD最易发生的节段。PLIF与TLIF手术组在ASD发生时间和发生率方面没有差异。

[Objective] To determine the incidence and the risk factors of adjacent segment degeneration （ASD） after L4-5 fusion with posterior lumbar interbody fusion （PLIF） or transforaminal lumbar interbody fusion （TLIF） . [Methods] We retrospectively reviewed medical records of all the patients who underwent the L1-5 fusion by PLIF or TLIF for degenerative spinal disease and followed up more thanlyear in the past ten years in our hospital. ASD was defined as clinical and/or radiographic evidence of degenerative spinal disease that required reoperation at the adjacent discs above or below L1-5 level. [Resuits] Of the 355 patients who underwent spinal fusion at the L4-5 level, the ASD occurred in 42 patients （54 segments）, including 3 patients at L1-2 （5%） , 13 at L2-3 （24%） , 29 at L3-4, （54%） and 9 at LsS, （17%） , associated with a total incidence of 11.8%. In term of involved segment, the L3.4 was the most susceptible level （P〈O.001） . Although The incidences of ASD in the PLIF was higher than the TLIF, there was not statistical difference between them （14% versus 9.5%, P=0.189） . The cephalic ASD was statistically more common than the caudal ASD in both the PLIF （P〈0.001） and TLIF （P〈0.001） . The average elapsed time to ASD was 2 years after L-s fusion, however, no a statistical difference was noted between the PLIF and TLIF in time of ASD happened based on a Kaplan-Meier analysis （P=0.1559） . [Conclusions] The cumulative inci- dence of ASD requiring reoperation is 12% over a mean period of 2 years with the most susceptible level at the L3-4 Both the PLIF and TLIF have similar incidences of ASD.