Study Design: 

Prospective cross-sectional cohort study.

Objectives: 

The main purpose of this study was to evaluate the association between demographical, surgery-related and morphologic parameters, and the development or progress of adjacent segment degeneration (ASD) after short-segment lumbar fusions.

Summary of Background Data: 

ASD is a major long-term complication after lumbar fusions. Possible risk factors are related to the patients’ demographics, spinopelvic anatomy, or preoperative lumbar intervertebral disk conditions, but the role of these parameters is still not clear.

Methods: 

A prospective cross-sectional study of 100 patients who underwent 1- or 2-level open lumbar transforaminal interbody fusions due to a lumbar degenerative pathology was conducted. Demographical, radiologic findings, and magnetic resonance imaging features were analyzed to identify factors associated with ASD in 5-year follow-up.

Results: 

ASD patients showed higher level of pain (P=0.004) and disability (P=0.020) at follow-up. In univariate analysis, older age (P=0.007), upper-level lumbar fusion (P=0.007), lower L4-S1 lordosis (P=0.039), pelvic incidence-lumbar lordosis mismatch (P=0.021), Pfirrmann grade III or higher disk degeneration (P=0.002), and the presence of disk bulge/protrusion (P=0.007) were associated with ASD. In multivariate analysis, the presence of major degenerative sign (disk degeneration and/or disk bulge) was the significant predictor for developing ASD (odds ratio: 3.85, P=0.006).

Conclusion: 

By examining the role of different patient- and procedure-specific factors, we found that preoperative major degenerative signs at the adjacent segment increase the risk of ASD causing significantly worse outcome after short-segment lumbar fusion. On the basis of our results, adjacent disk conditions should be considered carefully during surgical planning.

中文翻译：

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患者特异性因素和脊柱骨盆对齐对短节段腰椎融合后相邻节段退变发展的影响相邻节段退变的发展

学习规划： 

前瞻性横断面队列研究。

目标： 

本研究的主要目的是评估人口统计学、手术相关和形态学参数之间的关联，以及短节段腰椎融合术后相邻节段退变（ASD）的发生或进展。

背景数据摘要： 

ASD 是腰椎融合术后主要的长期并发症。可能的危险因素与患者的人口统计、脊柱骨盆解剖或术前腰椎间盘状况有关，但这些参数的作用仍不清楚。

方法： 

对 100 名因腰椎退行性病变而接受 1 级或 2 级开放腰椎椎间孔椎间融合术的患者进行了一项前瞻性横断面研究。对人口统计学、放射学结果和磁共振成像特征进行分析，以确定 5 年随访中与 ASD 相关的因素。

结果： 

自闭症谱系障碍患者在随访中表现出较高程度的疼痛（P =0.004）和残疾（P =0.020）。单因素分析显示，年龄较大（P =0.007）、上段腰椎融合（P =0.007）、L4-S1前凸较低（P =0.039）、骨盆倾角-腰椎前凸不匹配（P =0.021）、Pfirrmann III级或较高的椎间盘退变（P =0.002）和椎间盘突出/突出（P =0.007）与 ASD 相关。在多变量分析中，主要退变体征（椎间盘退变和/或椎间盘膨出）的存在是发生 ASD 的重要预测因素（比值比：3.85，P = 0.006）。

结论： 

通过检查不同患者和手术特定因素的作用，我们发现术前相邻节段的主要退行性征象会增加 ASD 的风险，导致短节段腰椎融合后的结果明显更差。根据我们的结果，在手术计划期间应仔细考虑邻近的椎间盘状况。