Isobar EVO非融合动态固定治疗腰椎融合术后邻椎病的中期疗效

Mid-term effect of Isobar EVO non-fusion dynamic fixation in the treatment of adjacent segment disease after lumbar fusion

背景:腰椎融合术后邻椎病的治疗是脊柱外科的研究热点,传统延长融合节段的手术有可能加速邻椎病的再次出现。以椎弓根螺钉为基础的非融合技术在治疗腰椎退行性疾病和预防邻近节段退变中表现出良好的中短期疗效,但采用非融合技术治疗腰椎融合术后邻椎病的临床疗效亟待研究。目的:评估Isobar EVO非融合动态固定治疗腰椎融合术后邻椎病的效果。方法:选择2013年7月至2017年12月于东直门医院因保守治疗无效后再次手术的邻椎病患者,纳入了其中15例接受Isobar EVO原位非融合动态稳定治疗的患者,并回顾了病历、手术报告和X射线成像研究。比较手术前后的临床结果(包括腰痛和下肢痛目测类比评分、腰椎功能障碍指数、SF-36量表生理健康评分)和影像学测量指标(包括手术节段及上位邻近节段活动度、手术节段前凸角和腰椎前凸角、手术节段及上位邻近节段平均间隙高度指数)。结果与结论:15例患者完成了至少3年的随访。(1)临床结果:末次随访时各项评分较术前有显著改善(P<0.05),但随访各时段之间比较无显著差异(P>0.05)。(2)影像学测量指标:末次随访时,手术节段活动度较术前明显减少[(3.16±0.45)°vs.(6.32±1.81)°,P<0.05],上位邻近节段活动度较术前明显增加[(5.51±1.22)°vs.(4.87±1.47)°,P<0.05],腰椎前凸角较术前明显增加[(30.95±8.96)°vs.(27.12±9.67)°,P<0.05],手术节段前凸角较术前明显增加[(11.32±4.86)°vs.(10.14±6.44)°,P<0.05],手术节段平均间隙高度指数较术前明显增大(33.23±3.83 vs.32.79±4.06,P<0.05),但上位邻近节段平均间隙高度指数较术前差异无统计学意义(P>0.05);以上指标在术后随访各时段之间相比差异均无统计学意义(P>0.05)。所有病例在随访周期内未见内置物松动,未再次发生邻椎病。(3)结论:Isobar EVO非融合动态固定是治疗邻椎病的有效方式,临床效果明显。术后3年以上随访结果显示该术式可在一定程度上预防再手术后邻椎病的发生,长期效果有待于进一步随访的结果和更高级别循证医学证据的支持。

BACKGROUND:The treatment of adjacent spondylopathy after lumbar fusion is a research hotspot in spine surgery.Traditional surgery to extend the fusion segment may accelerate the reappearance of adjacent segment disease.The non-fusion pedicle screw system based on pedicle screws has shown excellent short-and mid-term results in the treatment of lumbar degenerative diseases and the prevention of adjacent segment degeneration.However,reports on the use of non-fusion technology to treat adjacent segment disease after lumbar fusion need to be studied urgently.OBJECTIVE:To assess the postoperative outcome of non-fusion dynamic stabilization in situ with the Isobar EVO System for adjacent segment disease.METHODS:Patients with adjacent segment disease who were re-operated at Dongzhimen Hospital from July 2013 to December 2017 due to ineffective conservative treatment were selected.Fifteen patients with adjacent segment disease who received Isobar EVO in situ non-fusion dynamic stabilization treatment were enrolled.Medical records,surgical reports,and X-ray imaging studies were reviewed.The following two groups of indicators were compared before and after operation:low back pain visual analogue scale score and lower limb pain visual analogue scale score,Oswestry Disability Index,SF-36 scale physical health score,range of motion of the operative segment,the motion of the upper adjacent segment,the lordotic angle of the operative segment and the angle of lumbar spine,the disc of height index at surgical segment,and the disc of height index at superior segment.RESULTS AND CONCLUSION:Fifteen patients completed at least 3 years of follow-up.(1)Clinical results:At the last follow-up,the scores were significantly improved compared with those before the operation(P<0.05),but there was no significant difference between different periods of the follow-up(P>0.05).(2)Imaging measurement:At the last follow-up,mean range of motion of the segment was significantly reduced compared with that before the operation[(3.16±0.45)°vs.(6.32±1.81)°,P<0.05];the average motion range of the superior segment was significantly increased compared with that before the operation[(5.51±1.22)°vs.(4.87±1.47)°,P<0.05].The lumbar lordosis angle was significantly increased compared with that before the operation[(30.95±8.96)°vs.(27.12±9.67)°,P<0.05];the lordosis angle of the operation segment was significantly increased than that before the operation[(11.32±4.86)°vs.(10.14±6.44)°,P<0.05].Disc of height index at surgical segment was significantly higher than that before the operation(33.23±3.83 vs.32.79±4.06,P<0.05).However,disc of height index at superior segment was not statistically different from preoperatively(P>0.05).There was no statistically significant difference in above indexes between each period of follow-up after operation(P>0.05).In all cases,there was no loosening of the internal body during the follow-up period,and no adjacent segment disease occurred again.(3)It is concluded that Isobar EVO non-fusion dynamic fixation is an effective way to treat adjacent segment disease,and the clinical effect is obvious.The follow-up results for more than 3 years after surgery show that this operation can prevent the occurrence of adjacent segment disease after reoperation to a certain extent.The long-term effect needs to be supported by the results of further follow-up and higher-level evidence-based medicine.