腰椎Topping-off术式的临床应用及相关研究进展
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摘要
<正>腰椎椎间融合术联合椎弓根钉棒内固定已在临床上广泛应用,疗效确切,是治疗多种腰椎退行性疾患的"金标准"。但应用这种经典术式长期随访也会带来新的挑战,如假关节形成、活动度下降以及邻近节段退变(adjacent segment degeneration,ASD)等~([1-2])。随着越来越多非融合技术应用于临床,将两者混搭使用扬长避短,已初显成效。现对腰椎混搭手术(hybrid surgery,HS)常见的手术
Lumbar topping-off surgery is innovative, which synthesizes the lumbar fusion surgery and nonfusion surgery to develop each advantages and avoid each disadvantages. This type of surgery is reported widely in Chinese and English literatures. Moreover, this surgery is increasingly developing with the innovation of lumbar instruments, and the basic biomechanical studies are increasing as well. It is imperative to review these relevant literatures and introduce the clinical issues such as indications, outcomes, adjacent segment degeneration prevention and complications, and expect the clinical application value of the topping-off surgery.
Lumbar topping-off surgery is innovative, which synthesizes the lumbar fusion surgery and nonfusion surgery to develop each advantages and avoid each disadvantages. This type of surgery is reported widely in Chinese and English literatures. Moreover, this surgery is increasingly developing with the innovation of lumbar instruments, and the basic biomechanical studies are increasing as well. It is imperative to review these relevant literatures and introduce the clinical issues such as indications, outcomes, adjacent segment degeneration prevention and complications, and expect the clinical application value of the topping-off surgery.
引文
[1]Fei H,Xu J,Wang S,et al.Comparison between posterior dynamic stabilization and posterior lumbar interbody fusion in the treatment of degenerative disc disease:a prospective cohort study[J].J Orthop Surg Res,2015,10:87.
[2]Hilibrand AS,Robbins M.Adjacent segment degeneration and adjacent segment disease:the consequences of spinal fusion[J].Spine J,2004,4(6 Suppl):S190-194.
[3]Howorth MB.Evolution of spinal fusion[J].Ann Surg,1943,117(2):278-289.
[4]Capener N.Spondylolisthesis[J].Br J Surg,1932,19(75):374-386.
[5]Mobbs RJ,Loganathan A,Yeung V,et al.Indications for anterior lumbar interbody fusion[J].Orthop Surg,2013,5(3):153-163.
[6]Lipson SJ.Spinal-fusion surgery-advances and concerns[J].N Engl J Med,2004,350(7):643-644.
[7]Dhall SS,Choudhri TF,Eck JC,et al.Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine.Part 5:correlation between radiographic outcome and function[J].J Neurosurg Spine,2014,21(1):31-36.
[8]Sengupta DK,Mulholland RC.Fulcrum assisted soft stabilization system:a new concept in the surgical treatment of degenerative low back pain[J].Spine,2005,30(9):1019-1029.
[9]Harrop JS,Youssef JA,Maltenfort M,et al.Lumbar adjacent segment degeneration and disease after arthrodesis and total disc arthroplasty[J].Spine,2008,33(15):1701-1707.
[10]Pintauro M,Duffy A,Vahedi P,et al.Interspinous implants:are the new implants better than the last generation?A review[J].Curr Rev Musculoskelet Med,2017,10(2):189-198.
[11]Holt RT,Majd ME,Isaza JE,et al.Complications of lumbar artificial disc replacement compared to fusion:results from the prospective,randomized,multicenter US Food and Drug Administration Investigational Device Exemption Study of the charitéartificial disc[J].SAS J,2007,1(1):20-27.
[12]Lee CH,Kim YE,Lee HJ,et al.Biomechanical effects of hybrid stabilization on the risk of proximal adjacentsegment degeneration following lumbar spinal fusion using an interspinous device or a pedicle screw-based dynamic fixator[J].J Neurosurg Spine,2017,27(6):643-649.
[13]Khoueir P,Kim KA,Wang MY.Classification of posterior dynamic stabilization devices[J].Neurosurg Focus,2007,22(1):E3.
[14]Chen XL,Guan L,Liu YZ,et al.Interspinous dynamic stabilization adjacent to fusion versus double-segment fusion for treatment of lumbar degenerative disease with a minimum follow-up of three years[J].Int Orthop,2016,40(6):1275-1283.
[15]Lee CH,Hyun SJ,Kim KJ,et al.The efficacy of lumbar hybrid stabilization using the DIAM to delay adjacent segment degeneration:an intervention comparison study with a minimum 2-year follow-up[J].Neurosurgery,2013,73(2 Suppl Operative):ons224-231.
[16]Zhu Z,Liu C,Wang K,et al.Topping-off technique prevents aggravation of degeneration of adjacent segment fusion revealed by retrospective and finite element biomechanical analysis[J].J Orthop Surg Res,2015,10:10.
[17]Siewe J,Otto C,Knoell P,et al.Comparison of standard fusion with a“topping off”system in lumbar spine surgery:a protocol for a randomized controlled trial[J].BMC Musculoskelet Disord,2011,12:239.
[18]Christian H,Rolf S,Miguel P,et al.The use of the DTOTMhybrid dynamic device:a clinical outcome-and radiologicalbased prospective clinical trial[J].BMC Musculoskelet Disord,2018,19:199.
[19]Kashkoush A,Agarwal N,Paschel E,et al.Evaluation of a hybrid dynamic stabilization and fusion system in the Lumbar Spine:A 10 year experience[J].Cureus,2016,8(6):e637.
[20]Maserati MB,Tormenti MJ,Panczykowski DM,et al.The use of a hybrid dynamic stabilization and fusion system in the lumbar spine:preliminary experience[J].Neurosurg Focus,2010,28(6):E2.
[21]Coe JD,Kitchel SH,Meisel HJ,et al.NFlex dynamic stabilization system:two-year clinical outcomes of multi-center study[J].J Korean Neurosurg Soc,2012,51(6):343-349.
[22]Bredow J,L?hrer L,Oppermann J,et al.Pathoanatomic risk factors for instability and adjacent segment disease in lumbar spine:how to use topping off[J].Biomed Res Int,2017.
[23]Siewe J,Bredow J,Oppermann J,et al.Evaluation of efficacy of a new hybrid fusion device:a randomized,two-centre controlled trial[J].BMC Musculoskelet Disord,2014,15:294.
[24]Liu HY,Zhou J,Wang B,et al.Comparison of Toppingoff and posterior lumbar interbody fusion surgery in lumbar degenerative disease:a retrospective study[J].Chin Med J(Engl),2012,125(22):3942-3946.
[25]Lee SE,Jahng TA,Kim HJ.Hybrid surgery combined with dynamic stabilization system and fusion for the multilevel degenerative disease of the lumbosacral spine[J].Int J Spine Surg,2015,9:45.
[26]Formica M,Cavagnaro L,Basso M,et al.Is it possible to preserve lumbar lordosis after hybrid stabilization?Preliminary results of a novel rigid-dynamic stabilization system in degenerative lumbar pathologies[J].Eur Spine J,2015,24(Suppl 7):S849-854.
[27]Lu K,Liliang PC,Wang HK,et al.Reduction in adjacentsegment degeneration after multilevel posterior lumbar interbody fusion with proximal DIAM implantation[J].J Neurosurg Spine,2015,23(2):190-196.
[28]Korovessis P,Repantis T,Zacharatos S,et al.Does Wallis implant reduce adjacent segment degeneration above lumbosacral instrumented fusion[J]?Eur Spine J,2009,18(6):830-840.
[29]Putzier M,Hoff E,Tohtz S,et al.Dynamic stabilization adjacent to single-level fusion:Part II.No clinical benefit for asymptomatic,initially degenerated adjacent segments after 6years follow-up[J].Eur Spine J,2010,19(12):2181-2189.
[30]Gao J,Zhao W,Zhang X,et al.MRI analysis of the ISOBARTTL internal fixation system for the dynamic fixation of intervertebral discs:a comparison with rigid internal fixation[J].J Orthop Surg Res,2014,9:43.
[31]曹亮亮,徐建广,连小峰,等.Topping-off术后上位相邻节段的MRI表现及近期疗效[J].中国矫形外科杂志,2017,25(17):1552-1557.
[32]李冬月,海涌,孟祥龙,等.Topping-off与融合固定治疗退行性腰椎疾病的临床疗效及邻近节段退变的对比研究[J].中国矫形外科杂志,2017,25(11):967-973.
[33]许有银,朱震奇,刘海鹰,等.Topping-off术后腰椎上位相邻节段退变的影像学分析[J].中国矫形外科杂志,2014,22(7):577-583.
[34]王顺义.邻近节段辅以k-rod动态固定在腰椎融合术治疗腰椎退行性疾病的临床应用[J].颈腰痛杂志,2017,38(5):495-497.
[35]刘照树.Isobar动态固定联合腰椎融合与椎弓根内固定联合椎间融合术治疗腰椎退行性变临床疗效对比[J].医药论坛杂志,2018,39(6):100-101.
[36]Herren C,Beckmann A,Meyer S,et al.Biomechanical testing of a PEEK-based dynamic instrumentation device in a lumbar spine model[J].Clin Biomech(Bristol,Avon),2017,44:67-74.
[37]Che W,Chen Q,Ma YQ,et al.Single-level rigid fixation combined with coflex:a biomechanical study[J].Med Sci Monit,2016,22:1022-1027.
[38]Kong C,Lu S,Hai Y,et al.Biomechanical effect of interspinous dynamic stabilization adjacent to single-level fusion on range of motion of the transition segment and the adjacent segment[J].Clin Biomech(Bristol,Avon),2015,30(4):355-359.
[39]马亮,许永涛,佘远举.腰椎融合联合上一节段棘突间动态固定的有限元分析[J].中国组织工程研究,2018,22(23):3647-3653.
[2]Hilibrand AS,Robbins M.Adjacent segment degeneration and adjacent segment disease:the consequences of spinal fusion[J].Spine J,2004,4(6 Suppl):S190-194.
[3]Howorth MB.Evolution of spinal fusion[J].Ann Surg,1943,117(2):278-289.
[4]Capener N.Spondylolisthesis[J].Br J Surg,1932,19(75):374-386.
[5]Mobbs RJ,Loganathan A,Yeung V,et al.Indications for anterior lumbar interbody fusion[J].Orthop Surg,2013,5(3):153-163.
[6]Lipson SJ.Spinal-fusion surgery-advances and concerns[J].N Engl J Med,2004,350(7):643-644.
[7]Dhall SS,Choudhri TF,Eck JC,et al.Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine.Part 5:correlation between radiographic outcome and function[J].J Neurosurg Spine,2014,21(1):31-36.
[8]Sengupta DK,Mulholland RC.Fulcrum assisted soft stabilization system:a new concept in the surgical treatment of degenerative low back pain[J].Spine,2005,30(9):1019-1029.
[9]Harrop JS,Youssef JA,Maltenfort M,et al.Lumbar adjacent segment degeneration and disease after arthrodesis and total disc arthroplasty[J].Spine,2008,33(15):1701-1707.
[10]Pintauro M,Duffy A,Vahedi P,et al.Interspinous implants:are the new implants better than the last generation?A review[J].Curr Rev Musculoskelet Med,2017,10(2):189-198.
[11]Holt RT,Majd ME,Isaza JE,et al.Complications of lumbar artificial disc replacement compared to fusion:results from the prospective,randomized,multicenter US Food and Drug Administration Investigational Device Exemption Study of the charitéartificial disc[J].SAS J,2007,1(1):20-27.
[12]Lee CH,Kim YE,Lee HJ,et al.Biomechanical effects of hybrid stabilization on the risk of proximal adjacentsegment degeneration following lumbar spinal fusion using an interspinous device or a pedicle screw-based dynamic fixator[J].J Neurosurg Spine,2017,27(6):643-649.
[13]Khoueir P,Kim KA,Wang MY.Classification of posterior dynamic stabilization devices[J].Neurosurg Focus,2007,22(1):E3.
[14]Chen XL,Guan L,Liu YZ,et al.Interspinous dynamic stabilization adjacent to fusion versus double-segment fusion for treatment of lumbar degenerative disease with a minimum follow-up of three years[J].Int Orthop,2016,40(6):1275-1283.
[15]Lee CH,Hyun SJ,Kim KJ,et al.The efficacy of lumbar hybrid stabilization using the DIAM to delay adjacent segment degeneration:an intervention comparison study with a minimum 2-year follow-up[J].Neurosurgery,2013,73(2 Suppl Operative):ons224-231.
[16]Zhu Z,Liu C,Wang K,et al.Topping-off technique prevents aggravation of degeneration of adjacent segment fusion revealed by retrospective and finite element biomechanical analysis[J].J Orthop Surg Res,2015,10:10.
[17]Siewe J,Otto C,Knoell P,et al.Comparison of standard fusion with a“topping off”system in lumbar spine surgery:a protocol for a randomized controlled trial[J].BMC Musculoskelet Disord,2011,12:239.
[18]Christian H,Rolf S,Miguel P,et al.The use of the DTOTMhybrid dynamic device:a clinical outcome-and radiologicalbased prospective clinical trial[J].BMC Musculoskelet Disord,2018,19:199.
[19]Kashkoush A,Agarwal N,Paschel E,et al.Evaluation of a hybrid dynamic stabilization and fusion system in the Lumbar Spine:A 10 year experience[J].Cureus,2016,8(6):e637.
[20]Maserati MB,Tormenti MJ,Panczykowski DM,et al.The use of a hybrid dynamic stabilization and fusion system in the lumbar spine:preliminary experience[J].Neurosurg Focus,2010,28(6):E2.
[21]Coe JD,Kitchel SH,Meisel HJ,et al.NFlex dynamic stabilization system:two-year clinical outcomes of multi-center study[J].J Korean Neurosurg Soc,2012,51(6):343-349.
[22]Bredow J,L?hrer L,Oppermann J,et al.Pathoanatomic risk factors for instability and adjacent segment disease in lumbar spine:how to use topping off[J].Biomed Res Int,2017.
[23]Siewe J,Bredow J,Oppermann J,et al.Evaluation of efficacy of a new hybrid fusion device:a randomized,two-centre controlled trial[J].BMC Musculoskelet Disord,2014,15:294.
[24]Liu HY,Zhou J,Wang B,et al.Comparison of Toppingoff and posterior lumbar interbody fusion surgery in lumbar degenerative disease:a retrospective study[J].Chin Med J(Engl),2012,125(22):3942-3946.
[25]Lee SE,Jahng TA,Kim HJ.Hybrid surgery combined with dynamic stabilization system and fusion for the multilevel degenerative disease of the lumbosacral spine[J].Int J Spine Surg,2015,9:45.
[26]Formica M,Cavagnaro L,Basso M,et al.Is it possible to preserve lumbar lordosis after hybrid stabilization?Preliminary results of a novel rigid-dynamic stabilization system in degenerative lumbar pathologies[J].Eur Spine J,2015,24(Suppl 7):S849-854.
[27]Lu K,Liliang PC,Wang HK,et al.Reduction in adjacentsegment degeneration after multilevel posterior lumbar interbody fusion with proximal DIAM implantation[J].J Neurosurg Spine,2015,23(2):190-196.
[28]Korovessis P,Repantis T,Zacharatos S,et al.Does Wallis implant reduce adjacent segment degeneration above lumbosacral instrumented fusion[J]?Eur Spine J,2009,18(6):830-840.
[29]Putzier M,Hoff E,Tohtz S,et al.Dynamic stabilization adjacent to single-level fusion:Part II.No clinical benefit for asymptomatic,initially degenerated adjacent segments after 6years follow-up[J].Eur Spine J,2010,19(12):2181-2189.
[30]Gao J,Zhao W,Zhang X,et al.MRI analysis of the ISOBARTTL internal fixation system for the dynamic fixation of intervertebral discs:a comparison with rigid internal fixation[J].J Orthop Surg Res,2014,9:43.
[31]曹亮亮,徐建广,连小峰,等.Topping-off术后上位相邻节段的MRI表现及近期疗效[J].中国矫形外科杂志,2017,25(17):1552-1557.
[32]李冬月,海涌,孟祥龙,等.Topping-off与融合固定治疗退行性腰椎疾病的临床疗效及邻近节段退变的对比研究[J].中国矫形外科杂志,2017,25(11):967-973.
[33]许有银,朱震奇,刘海鹰,等.Topping-off术后腰椎上位相邻节段退变的影像学分析[J].中国矫形外科杂志,2014,22(7):577-583.
[34]王顺义.邻近节段辅以k-rod动态固定在腰椎融合术治疗腰椎退行性疾病的临床应用[J].颈腰痛杂志,2017,38(5):495-497.
[35]刘照树.Isobar动态固定联合腰椎融合与椎弓根内固定联合椎间融合术治疗腰椎退行性变临床疗效对比[J].医药论坛杂志,2018,39(6):100-101.
[36]Herren C,Beckmann A,Meyer S,et al.Biomechanical testing of a PEEK-based dynamic instrumentation device in a lumbar spine model[J].Clin Biomech(Bristol,Avon),2017,44:67-74.
[37]Che W,Chen Q,Ma YQ,et al.Single-level rigid fixation combined with coflex:a biomechanical study[J].Med Sci Monit,2016,22:1022-1027.
[38]Kong C,Lu S,Hai Y,et al.Biomechanical effect of interspinous dynamic stabilization adjacent to single-level fusion on range of motion of the transition segment and the adjacent segment[J].Clin Biomech(Bristol,Avon),2015,30(4):355-359.
[39]马亮,许永涛,佘远举.腰椎融合联合上一节段棘突间动态固定的有限元分析[J].中国组织工程研究,2018,22(23):3647-3653.