关键词: 椎弓根螺钉, 脊椎, 腰骶椎融合, 相邻节段病变, 应力改变, 椎间盘退变, 间隙狭窄, 椎体滑脱, 骨质疏松, 治疗

Abstract:

BACKGROUND: Pedicle screw internal fixation and lumbosacral fusion has become the main treatment method for various spinal diseases, and the postoperative complications have attracted more and more attention of the scholars, while the adjacent segment disease is the main complication which seriously affects the efficacy of interbody fusion and internal fixation.
OBJECTIVE: To investigate the course and treatment efficacy of adjacent segment disease after posterior pedicle screw internal fixation and lumbosacral fusion.
METHODS: A retrospective analysis was performed on 536 patients (male 341, female 195, age 34-71, average in 51.3 years old) treated with posterior pedicle screw internal fixation and fusion in the cervical vertebrae fusion cage from April 1998 to December 2011. Among the patients, 412 cases experienced single segment fusion and 124 cases with multi-segment fusion. The patients with adjacent segment disease received lateral lumbar spine X-ray examination, over flexion-extension position X-ray examination and magnetic resonance image examination of the lumbar spine, and the changes of adjacent intervertebral angle and the slip distance and changes of upper vertebral were measured on the X-ray film, then the treatment effect was evaluated according to the Japanese Orthopaedic Association sores and Oswestry disability index. We investigated the causes, incidence rate, the potential risks and the treatment of adjacent segment disease according to the statistical analysis.
RESULTS AND CONCLUSION: Among the 536 patients treated with posterior pedicle screw internal fixation and lumbosacral fusion, 31 cases of patients with adjacent segment disease symptom, 18 cases with single segment fusion, 13 cases with multi-segment fusion, 6 cases has lumbar disc herniation, 13 cases has lumbar instability 9 cases affected lumbar spondylolis thesis and 3 cases has lumbar spinal stenosis. All the patients were followed-up for 9-64 months, average in 26.7 months. According to the Japanese Orthopaedic Association sores, excellent in 4 cases, good in 11 cases, average in 3 cases, poor in 1 case, and the excellent and good rate was 78.94%. The Oswestry disability index was reduced by an average of 33.8 (8.5-42.3), the improvement rate was 79.91%. Statistical t-test showed that there was significant difference of average age, ration of fusion segments, Japanese Orthopaedic Association sores and the Oswestry disability index among the patients with adjacent segment disease (P < 0.05). There was adjacent segment disease after treated with posterior pedicle screw internal fixation and lumbosacral fusion, the incidence may related with the biomechanics changes of the adjacent vertebral. Majority of adjacent segment disease patients achieved the good results after reoperation; early consideration of the pathogenic potential factors is the main means to prevent the incidence of adjacent segment disease.