Objective : The aim of this study is to investigate predictable risk factors for radiologic degeneration of adjacent segment after lumbar fusion and preoperative radiologic features of patients who underwent additional surgery with adjacent segment degeneration. Methods : Between January 1995 and De...
Objective : The aim of this study is to investigate predictable risk factors for radiologic degeneration of adjacent segment after lumbar fusion and preoperative radiologic features of patients who underwent additional surgery with adjacent segment degeneration. Methods : Between January 1995 and December 2002, 201 patients who underwent lumbar fusion for degenerative conditions of lumbar spine were evaluated. We studied radiologic features, the method of operation, the length of fusion, age, sex, osteoporosis, and body mass index. Special attention was focused on, preoperative radiologic features of patients who required additional surgery were studied to detect risk factors for clinical deterioration. Results : Follow-up period ranged from 3 to 11 years. In our study, 61 [30%] patients developed adjacent segment degeneration, and 15 [7%] patients required additional surgery for neurologic deterioration. Age, the postoperative delay, facet volume, motion range, laminar inclination, facet tropism, and preexisting disc degeneration of adjacent segment considered as possible risk factors. Among these, laminar inclination and preexisting disc degeneration of adjacent segment were significantly correlated with clinical deterioration. Conclusion : The radiologic degeneration of adjacent segment after lumbar fusion can be predicted in terms of each preoperative radiologic factor, age and the postoperative delay. Laminar inclination and preexisting disc degeneration of adjacent segment have shown as strong risk factors for neurologic deterioration. Thus, careful consideration is warranted when these risk factors are present.
Objective : The aim of this study is to investigate predictable risk factors for radiologic degeneration of adjacent segment after lumbar fusion and preoperative radiologic features of patients who underwent additional surgery with adjacent segment degeneration. Methods : Between January 1995 and December 2002, 201 patients who underwent lumbar fusion for degenerative conditions of lumbar spine were evaluated. We studied radiologic features, the method of operation, the length of fusion, age, sex, osteoporosis, and body mass index. Special attention was focused on, preoperative radiologic features of patients who required additional surgery were studied to detect risk factors for clinical deterioration. Results : Follow-up period ranged from 3 to 11 years. In our study, 61 [30%] patients developed adjacent segment degeneration, and 15 [7%] patients required additional surgery for neurologic deterioration. Age, the postoperative delay, facet volume, motion range, laminar inclination, facet tropism, and preexisting disc degeneration of adjacent segment considered as possible risk factors. Among these, laminar inclination and preexisting disc degeneration of adjacent segment were significantly correlated with clinical deterioration. Conclusion : The radiologic degeneration of adjacent segment after lumbar fusion can be predicted in terms of each preoperative radiologic factor, age and the postoperative delay. Laminar inclination and preexisting disc degeneration of adjacent segment have shown as strong risk factors for neurologic deterioration. Thus, careful consideration is warranted when these risk factors are present.
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문제 정의
This study focuses on the long-term evolution of the adjacent segment in patients fused only for degenerative conditions of the lumbar spine such as degenerative spondylolisthesis, stenosis, and instability, excluding other pathologies. The p나rpose ofthis study is to clarify the predictable risk factors for radiologic degeneration ofadjacent segment after lumbar fusion, and to evaluate the preoperative radiologic features of patients who underwent additional surgery with adjacent segment degeneration.
가설 설정
B, 125°±8° in Group 2, and 138°+10° in Group 1.A. Preexisting disc degeneration at adjacent segment was 3.4±0.7 in Group l.B, 3.
A : Laminar inohon one at L3 was defined as the one formed by a straight line connecting the tip of the superior facet with the base 이 the inferior facet and a straight line connecting the midpoints of the anterior and posterior vertebral cortices on the lateral radiographs. B : Facet sagittalization and facet tropism at L3-갬 were taken from the computed tomography cut that was coplanar with the disc and transected the facet joints.
Preexisting facet hypertrophy of adjacent segment may deteriorate more easily after fusion because of the increased stress on the focet9,33,35,45). In this study, the more facet volume, the more adjacent segment degenerations. Besides the facet hypertrophy of adjacent segment, increased FEA was associated with the degeneration ofadjacent segment361.
제안 방법
Univariate association ofcontinuous variables was tested using Spearman rank correlation coefficients (is). Univariate and multivariate odd ratios and 95% confidence intervals ofrisk factors for adjacent segment degeneration were analyzed with the aid of unconditional logistic regression.
대상 데이터
T wo hundred and one patients who underwent lumbar fusion for degenerative conditions of the lumbar spine refractory to conservative treatment from January 1995 to December 2002 and followed for at least 3 years were included in this study. Follow-up rate in the current study was 71%.
Patients who underwent lumbar fusion for other pathologies such as spondylolysis, trauma, and neoplasms were excluded. The study group included 69 male patients and 132 female patients. Mean age at surgery was 53 years (range, 17-78 years) and the average follow-up period was 73 months (range, 37- 130 months).
데이터처리
Categorical variables were compared using the Fisher exact two-tailed test, the Pearson chi-square test, or the test for linear trend. Continuous variables were compared between groups by applying the Mann-Whitney U-test or t-tests. Univariate association ofcontinuous variables was tested using Spearman rank correlation coefficients (is).
Continuous variables were compared between groups by applying the Mann-Whitney U-test or t-tests. Univariate association ofcontinuous variables was tested using Spearman rank correlation coefficients (is). Univariate and multivariate odd ratios and 95% confidence intervals ofrisk factors for adjacent segment degeneration were analyzed with the aid of unconditional logistic regression.
이론/모형
, Chicago, IL). Categorical variables were compared using the Fisher exact two-tailed test, the Pearson chi-square test, or the test for linear trend. Continuous variables were compared between groups by applying the Mann-Whitney U-test or t-tests.
We also measured laminar inclination angle, facet sagittalization, facet tropism, facet joint volume5,18), preexisting disc degeneration and stenosis at the adjacent level, sagittal alignment at the fused segment, and adjacent segment motion range. Lumbar lordosis at LI and S1 and lordosis at the fused segment were measured by Cobbs method with anteroposterior and lateral standing radiographs24). The laminar inclination angle at adjacent segment was defined as the angle formed by a straight line connecting the tip of the superior facet with the base of the inferior fecet and a straight line connecting the midpoints of the anterior and posterior vertebral cortices on the lateral radiographs as described281 (Fig.
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