腰椎后路固定融合术后邻近节段退变的研究进展
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摘要
腰椎后路固定融合术应用于腰椎退行性疾病的治疗取得了良好的效果,大量研究证明了这种手术的有效性和可靠性,但术后造成邻近节段退行性变或加剧已存在的退行性变的问题日益突出,受到了学者们的重视与关注。邻近节段退变是腰椎后路固定融合术后最常见的病变,其发生机制及影响因素,如何有效治疗及预防退变的发生成为研究的热点。大部分学者研究认为,固定融合术后邻近节段活动度增加、椎间盘内压力增高以及关节突关节负荷增大等生物力学改变是导致邻近节段退变发生的主要原因,许多研究主要集中于评估和分析各因素对邻近节段退变的影响程度。
Posterior lumbar interbody fusion treatment of lumbar degenerative disease has achieved good results,and a large number of studies have proved the effectiveness and reliability of this operation,but adjacent segment deterioration caused by operation or aggravation of existing deterioration are also becoming increasingly prominent,attracting the attention of scholars in the field. The adjacent segment deterioration is the most common lesion of posterior lumbar interbody fusion,and its mechanism and influencing factors,and effective treatment and prevention of adjacent segment degeneration have become the focus of the research. Most scholars believe that changes in biomechanics such as increased mobility of adjacent segments after fixed fusion,increased intradiscal pressure and articular process load are the main causes of adjacent segment deterioration,and many studies focus on assessing and analyzing the influence degree of different factors on adjacent segment deterioration.
Posterior lumbar interbody fusion treatment of lumbar degenerative disease has achieved good results,and a large number of studies have proved the effectiveness and reliability of this operation,but adjacent segment deterioration caused by operation or aggravation of existing deterioration are also becoming increasingly prominent,attracting the attention of scholars in the field. The adjacent segment deterioration is the most common lesion of posterior lumbar interbody fusion,and its mechanism and influencing factors,and effective treatment and prevention of adjacent segment degeneration have become the focus of the research. Most scholars believe that changes in biomechanics such as increased mobility of adjacent segments after fixed fusion,increased intradiscal pressure and articular process load are the main causes of adjacent segment deterioration,and many studies focus on assessing and analyzing the influence degree of different factors on adjacent segment deterioration.
引文
[1] Bohl DD,Mayo BC,Massel DH,et al. Incidence and risk factors for pneumonia following posterior lumbar fusion procedures:An ACS-NSQIP study[J]. Spine(Phila Pa 1976),2016,41(12):1058-1063.
[2] Vasudeva VS,Chi JH. Fusion surgery for lumbar spinal stenosis[J]. N Engl J Med,2016,375(6):601-605.
[3] Zhang C,Berven SH,Fortin M,et al. Adjacent segment degeneration versus disease after lumbar spine fusion for degenerative pathology:A systematic review with meta-analysis of the literature[J]. Clin Spine Surg,2016,29(1):21-29.
[4] Tye EY,Alentado VJ,Mroz TE,et al. Comparison of clinical and radiographic outcomes in patients receiving single-level transforaminal lumbar interbody fusion(TLIF)with removal of unilateral or bilateral facet joints[J]. Spine(Phila Pa 1976),2016,41(17):1039-1045.
[5]韩文兴,杨勇,靳志海.腰椎融合术后邻近节段退变研究进展[J].国际骨科学杂志,2013,34(5):336-339.
[6] Hikata T,Kamata M,Furukawa M. Risk factors for adjacent segment disease after posterior lumbar interbody fusion and efficacy of simultaneous decompression surgery for symptomatic adjacent segment disease[J]. Spinal Disord Tech,2012,27(2):70-75.
[7] Lund T,Oxland TR. Adjacent level disk disease-is it really a fusion disease[J]. Orthop Clin N Am,2011,42(4):529-541.
[8] Xia XP,Chen HL,Cheng HB. Prevalence of adjacent segment degeneration after spine surgery:A systematic review and metaanalysis[J]. Spine(Phila Pa 1976),2013,38(7):597-608.
[9] Imagama S,Kawakami N,Kanemura T,et al. Radiographic adjacent segment degeneration at five years after L4/5posterior lumbarinterbody fusion with pedicle screw instrumentation:Evaluation by computed tomography and annual screening with magnetic resonance imaging[J]. Spinal Disord Tech,2016,29(9):442-451.
[10] Yurube T,Hirata H,Kakutani K,et al. Notochordal cell disappearance and modes of apoptotic cell death in a rat tail static compression-induced disc degeneration model[J]. Arthritis Res Ther,2014,16(1):1-11.
[11] Maas ET,Juch J,Ostelo R,et al. Systematic review of patient history and physical examination to diagnose chronic low back pain originating from the facet joints[J]. Eur J Pain,2017,21(3):403-414.
[12] Videbaek TS,Egund N,Christensen FB,et al. Adjacent segment degeneration after lumbar spinal fusion:The impact of anterior column support:A randomized clinical trial with an eight-to thirteen-year magnetic resonance imaging follow-up[J]. Spine(Phila Pa 1976),2010,35(22):1955-1964.
[13]黄晓川,康两期,沙漠,等.相邻节段退行性变是自然过程还是融合相关的现象[J].中国骨与关节损伤杂志,2014,29(9):891-893.
[14] Lee CS,Hwang CJ,Lee SW,et al. Risk factors for adjacent segment disease after lumbar fusion[J]. Eur Spine J,2009,18(11):1637-1643.
[15] Anandjiwala J,Seo JY,Ha KY,et al. Adjacent segment degeneration after instrumented posterolateral lumbar fusion:A prospective cohort study with a minimum five-year follow-up[J]. Eur Spine J,2011,20(11):1951-1960.
[16] Lee JC,Kim Y,Soh JW,et al. Risk factors of adjacent segment disease requiring surgery after lumbar spinal fusion:Comparison of posterior lumbar interbody fusion and posterolateral fusion[J].Spine,2014,39(5):339-345.
[17] Kim KH,Lee SH,Shim CS. Adjacent segment disease after interbody fusion and pedicle screw fixations for isolated L4-L5spondylolisthesis:A minimum five-year follow-up[J]. Spine(Phila Pa1976),2010,35(6):625-634.
[18]高胜山,杨庆国,张银顺,等.腰椎固定节段与相邻椎间盘退化的影像学相关性[J].安徽医药,2013,17(5):814-817.
[19]黄觅,于淼,刘晓光,等.腰椎融合术后相邻节段退变的相关因素分析[J].中国脊柱脊髓杂志,2014,24(3):199-203.
[20] Ou CY,Lee TC,Lee TH,et al. Impact of body mass index on adjacent segment disease after lumbar fusion for degenerative spine disease[J]. Neurosurgery,2015,76(4):396-401.
[21] Liang J,Dong Y,Zhao H. Risk factors for predicting symptomatic adjacent segment degeneration requiring surgery in patients after posterior lumbar fusion[J]. J Orthop Surg Res,2014,9:97.
[22] Wang H,Ma L,Yang D,et al. Incidence and risk factors of adjacent segment disease following posterior decompression and instrumented fusion for degenerative lumbar disorders[J]. Medicine(Baltimore),2017,96(5):6032-6037.
[23] Park JY,Chin DK,Cho YE. Accelerated L5-S1segment degeneration after spinal fusion on and above L4-5:Minimum 4-year follow-up results[J]. Korean Neurosurg Soc,2009,45(2):81-84.
[24] Chen CS,Cheng CK,Liu CL. A biomechanical comparison of posterolateral fusion and posterior fusion in the lumbar spine[J].Spinal Disord Tech,2002,15(1):53-63.
[25] Ma J,Fan S,Zhao F. Intraoperative malposition of pedicle probe or screws:A potential cause of the acceleration of degeneration in superior adjacent intervertebral disc[J]. Med Hypotheses,2011,77(6):1102-1104.
[26]赵宇,杨开舜,李绍波.腰椎融合节段数与术后相邻节段退变及远期疗效的关系[J].西南国防医药,2013,23(4):388-391.
[27] Tang SH,Xu W. Does disc space height of fused segment affect adjacent disc degeneration in anterior lumbar interbody fusion?A radiological study[J]. Iran Red Crescent Med,2012,14(3):139-145.
[28] Soh J,Lee JC,Shin BJ. Analysis of risk factors for adjacent segment degeneration occurring more than 5 years after fusion with pedicle screw fixation for degenerative lumbar spine[J]. Asian Spine J,2013,7(4):273-281.
[29] Min JH,Jang JS,Jung BJ,et al. The clinical characteristics and risk factors for the adjacent segment degeneration in instrumented lumbar fusion[J]. Spinal Disord Tech,2008,21(5):305-309.
[30]李超,阮狄克,何勍,等.腰椎减压融合术中保留头端后部韧带复合体结构完整性对相邻节段退变的影响[J].脊柱外科杂志,2016,14(5):262-266.
[31] Hui W,Lei M,Yang D,et al. Incidence and risk factors for the progression of proximal junctional kyphosis in degenerative lumbar scoliosis following long instrumented posterior spinal fusion[J].Medicine(Baltimore),2016,95(32):4443-4449.
[32] Chen WJ,Lai PL,Niu CC,et al. Surgical treatment of adjacent instability after lumbar spine fusion[J]. Spine(Phila Pa 1976),2001,26(22):519-524.
[33] Palejwala SK,Sheen WA,Walter CM,et al. Minimally invasive lateral transpsoas interbody fusion using a stand-alone construct for the treatment of adjacent segment disease of the lumbar spine:Review of the literature and report of three cases[J]. Clin Neurol Neurosurg,2014,124(38):90-96.
[34]魏富鑫,钟锐,潘希敏,等.腰椎融合/非融合技术治疗L4/5退变性疾病的疗效及对相邻节段退变的影响[J].中国脊柱脊髓杂志,2014,24(10):892-899.
[35] 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].Orthop Surg Res,2015,10(1):1-6.
[36] Chou PH,Lin HH,An HS,et al. Could the topping-off technique be the preventive strategy against adjacent segment disease after pedicle screw-based fusion in lumbar degenerative diseases? A systematic review[J]. Biomed Res Int,2017,9(1):6-11.
[2] Vasudeva VS,Chi JH. Fusion surgery for lumbar spinal stenosis[J]. N Engl J Med,2016,375(6):601-605.
[3] Zhang C,Berven SH,Fortin M,et al. Adjacent segment degeneration versus disease after lumbar spine fusion for degenerative pathology:A systematic review with meta-analysis of the literature[J]. Clin Spine Surg,2016,29(1):21-29.
[4] Tye EY,Alentado VJ,Mroz TE,et al. Comparison of clinical and radiographic outcomes in patients receiving single-level transforaminal lumbar interbody fusion(TLIF)with removal of unilateral or bilateral facet joints[J]. Spine(Phila Pa 1976),2016,41(17):1039-1045.
[5]韩文兴,杨勇,靳志海.腰椎融合术后邻近节段退变研究进展[J].国际骨科学杂志,2013,34(5):336-339.
[6] Hikata T,Kamata M,Furukawa M. Risk factors for adjacent segment disease after posterior lumbar interbody fusion and efficacy of simultaneous decompression surgery for symptomatic adjacent segment disease[J]. Spinal Disord Tech,2012,27(2):70-75.
[7] Lund T,Oxland TR. Adjacent level disk disease-is it really a fusion disease[J]. Orthop Clin N Am,2011,42(4):529-541.
[8] Xia XP,Chen HL,Cheng HB. Prevalence of adjacent segment degeneration after spine surgery:A systematic review and metaanalysis[J]. Spine(Phila Pa 1976),2013,38(7):597-608.
[9] Imagama S,Kawakami N,Kanemura T,et al. Radiographic adjacent segment degeneration at five years after L4/5posterior lumbarinterbody fusion with pedicle screw instrumentation:Evaluation by computed tomography and annual screening with magnetic resonance imaging[J]. Spinal Disord Tech,2016,29(9):442-451.
[10] Yurube T,Hirata H,Kakutani K,et al. Notochordal cell disappearance and modes of apoptotic cell death in a rat tail static compression-induced disc degeneration model[J]. Arthritis Res Ther,2014,16(1):1-11.
[11] Maas ET,Juch J,Ostelo R,et al. Systematic review of patient history and physical examination to diagnose chronic low back pain originating from the facet joints[J]. Eur J Pain,2017,21(3):403-414.
[12] Videbaek TS,Egund N,Christensen FB,et al. Adjacent segment degeneration after lumbar spinal fusion:The impact of anterior column support:A randomized clinical trial with an eight-to thirteen-year magnetic resonance imaging follow-up[J]. Spine(Phila Pa 1976),2010,35(22):1955-1964.
[13]黄晓川,康两期,沙漠,等.相邻节段退行性变是自然过程还是融合相关的现象[J].中国骨与关节损伤杂志,2014,29(9):891-893.
[14] Lee CS,Hwang CJ,Lee SW,et al. Risk factors for adjacent segment disease after lumbar fusion[J]. Eur Spine J,2009,18(11):1637-1643.
[15] Anandjiwala J,Seo JY,Ha KY,et al. Adjacent segment degeneration after instrumented posterolateral lumbar fusion:A prospective cohort study with a minimum five-year follow-up[J]. Eur Spine J,2011,20(11):1951-1960.
[16] Lee JC,Kim Y,Soh JW,et al. Risk factors of adjacent segment disease requiring surgery after lumbar spinal fusion:Comparison of posterior lumbar interbody fusion and posterolateral fusion[J].Spine,2014,39(5):339-345.
[17] Kim KH,Lee SH,Shim CS. Adjacent segment disease after interbody fusion and pedicle screw fixations for isolated L4-L5spondylolisthesis:A minimum five-year follow-up[J]. Spine(Phila Pa1976),2010,35(6):625-634.
[18]高胜山,杨庆国,张银顺,等.腰椎固定节段与相邻椎间盘退化的影像学相关性[J].安徽医药,2013,17(5):814-817.
[19]黄觅,于淼,刘晓光,等.腰椎融合术后相邻节段退变的相关因素分析[J].中国脊柱脊髓杂志,2014,24(3):199-203.
[20] Ou CY,Lee TC,Lee TH,et al. Impact of body mass index on adjacent segment disease after lumbar fusion for degenerative spine disease[J]. Neurosurgery,2015,76(4):396-401.
[21] Liang J,Dong Y,Zhao H. Risk factors for predicting symptomatic adjacent segment degeneration requiring surgery in patients after posterior lumbar fusion[J]. J Orthop Surg Res,2014,9:97.
[22] Wang H,Ma L,Yang D,et al. Incidence and risk factors of adjacent segment disease following posterior decompression and instrumented fusion for degenerative lumbar disorders[J]. Medicine(Baltimore),2017,96(5):6032-6037.
[23] Park JY,Chin DK,Cho YE. Accelerated L5-S1segment degeneration after spinal fusion on and above L4-5:Minimum 4-year follow-up results[J]. Korean Neurosurg Soc,2009,45(2):81-84.
[24] Chen CS,Cheng CK,Liu CL. A biomechanical comparison of posterolateral fusion and posterior fusion in the lumbar spine[J].Spinal Disord Tech,2002,15(1):53-63.
[25] Ma J,Fan S,Zhao F. Intraoperative malposition of pedicle probe or screws:A potential cause of the acceleration of degeneration in superior adjacent intervertebral disc[J]. Med Hypotheses,2011,77(6):1102-1104.
[26]赵宇,杨开舜,李绍波.腰椎融合节段数与术后相邻节段退变及远期疗效的关系[J].西南国防医药,2013,23(4):388-391.
[27] Tang SH,Xu W. Does disc space height of fused segment affect adjacent disc degeneration in anterior lumbar interbody fusion?A radiological study[J]. Iran Red Crescent Med,2012,14(3):139-145.
[28] Soh J,Lee JC,Shin BJ. Analysis of risk factors for adjacent segment degeneration occurring more than 5 years after fusion with pedicle screw fixation for degenerative lumbar spine[J]. Asian Spine J,2013,7(4):273-281.
[29] Min JH,Jang JS,Jung BJ,et al. The clinical characteristics and risk factors for the adjacent segment degeneration in instrumented lumbar fusion[J]. Spinal Disord Tech,2008,21(5):305-309.
[30]李超,阮狄克,何勍,等.腰椎减压融合术中保留头端后部韧带复合体结构完整性对相邻节段退变的影响[J].脊柱外科杂志,2016,14(5):262-266.
[31] Hui W,Lei M,Yang D,et al. Incidence and risk factors for the progression of proximal junctional kyphosis in degenerative lumbar scoliosis following long instrumented posterior spinal fusion[J].Medicine(Baltimore),2016,95(32):4443-4449.
[32] Chen WJ,Lai PL,Niu CC,et al. Surgical treatment of adjacent instability after lumbar spine fusion[J]. Spine(Phila Pa 1976),2001,26(22):519-524.
[33] Palejwala SK,Sheen WA,Walter CM,et al. Minimally invasive lateral transpsoas interbody fusion using a stand-alone construct for the treatment of adjacent segment disease of the lumbar spine:Review of the literature and report of three cases[J]. Clin Neurol Neurosurg,2014,124(38):90-96.
[34]魏富鑫,钟锐,潘希敏,等.腰椎融合/非融合技术治疗L4/5退变性疾病的疗效及对相邻节段退变的影响[J].中国脊柱脊髓杂志,2014,24(10):892-899.
[35] 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].Orthop Surg Res,2015,10(1):1-6.
[36] Chou PH,Lin HH,An HS,et al. Could the topping-off technique be the preventive strategy against adjacent segment disease after pedicle screw-based fusion in lumbar degenerative diseases? A systematic review[J]. Biomed Res Int,2017,9(1):6-11.