退行性腰椎侧凸后路固定减压选择性植骨融合术后邻近节段退变的临床分析

Clinical analysis of adjacent segment degeneration after degenerative lumbar scoliosis treated with posterior instrumentation and decompression and selective fusion

目的观察后路椎弓根钉内固定、椎管减压、选择性椎间植骨融合术治疗退行性腰椎侧凸术后邻近节段退变发生的情况。方法回顾性分析自2012-01—2015-12采用后路椎弓根钉内固定、椎管减压、选择性椎间植骨融合术治疗的72例退行性腰椎侧凸,A组35例选择L4、5节段融合,B组37例选择L5S1节段融合。比较2组多节段固定比例、多椎板间隙减压比例,术后1周矢状面Cobb角、冠状面Cobb角、JOA评分,以及邻近节段退变发生率。结果 A组随访(14.1±1.2)个月,B组随访(12.8±0.2)个月。A组单椎板间隙减压比例低于B组,且多椎板间隙减压比例高于B组,多节段固定比例明显高于B组,差异有统计学意义(P <0.05)。B组1周矢状面Cobb角大于A组,差异有统计学意义(P <0.05);但2组术后1周冠状面Cobb角、JOA评分差异无统计学意义(P>0.05)。A组邻近节段退变发生率明显高于B组,差异有统计学意义(P <0.05)。结论后路椎弓根钉内固定、椎管减压、选择性椎间植骨融合术治疗退行性腰椎侧凸时,固定、减压节段越多,术后发生邻近节段退变的概率越大。

Objective To observe the adjacent segment degeneration after posterior pedicle screw fixation, spinal canal decompression and selective interbody fusion for treatment of degenerative lumbar scoliosis. Methods Retrospective analysis of 72 cases of degenerative lumbar scoliosis treated from January 2012 to December 2015 with posterior pedicle screw fixation, spinal canal decompression, and selective interbody fusion was conducted. L4,5 segment fusion was used in 35 cases （group A） while LsS1 segment fusion was used in 37 cases （group B）. In the two groups, the ratio of multi segment fixation and interlaminar decompression was compared, and the incidence of Cobb angle, Cobb angle of coronal plane, JOA score, and the incidence of adjacent segment degeneration were observed at one week after operation. Results Group A was followed up for （14.1±1.2） month, and group B was followed up （12.8±0.2） month. The proportion of single vertebral lamina decompression in group A was lower than that in group B, and the proportion of multiple laminectomy decompression in group A was higher than that in group B, and the ratio of multi segment fixation of group A was significantly higher than that of group B （P 〈0.05）. The Cobb angle of sagittal plane in group B was bigger than that in group A at one week, and the difference was statistically significant （P 〈0.05）, but there was no statistical difference in Cobb angle of sagittal plane and JOA score between the two groups at 1 week after the operation （P 〉0.05）. The incidence of adjacent segment degeneration in group A was significantly higher than that in group B, and the difference was statistically significant （P 〈0.05）. Conclusion In the treatment of degenerative lumbar scoliosis with posterior pedicle screw fixation, spinal canal decompression and selective intervertebral fusion, the more fixed and decompression segments, the greater the probability of adjacent segment degeneration.