腰椎融合术后邻近节段病变

摘要

腰椎融合手术会对邻近节段产生不良影响,导致邻近节段病变和退变,增加腰椎手术的翻修率并影响最终的手术疗效.当邻近节段仅仅出现影像学上新发的脊柱退行性改变或原有退变加重,但不合并相应的临床症状者称为邻近节段退变;合并有与影像学相对应的临床症状者称为邻近节段病变.一般认为脊柱融合术后引起邻近节段椎间盘和小关节突应力集中是邻近节段发生退变的主要致病机制,正常脊柱解剖结构受到破坏和自然退变进程也是重要致病因素.腰椎融合术后邻近节段病变和退变的发生率与患者年龄、体重、术后脊柱-骨盆的矢状位平衡以及术前邻近节段原有的退变基础有关;手术方式的选择,包括融合节段的数量、入路方式和是否采用非融合技术等对邻近节段病变和退变的发生有重要影响.在选择手术方案时应根据患者的病情采取一些必要的预防措施和手段,减少邻近节段病变和退变的发生.非融合技术、微创脊柱外科技术和Topping-off技术等可在一定程度上减少腰椎术后邻近节段病变和退变的发生;当合并邻近节段病变和退变高危因素时应该根据患者具体情况选择合适的治疗方案.%Lumbar spine fusion surgeries have adverse effects on adjacent segments and lead to adjacent segment disease and degeneration which increase the possibility of revision surgery and affect the final outcome.If new degeneration or aggravation of the primary degeneration in the adjacent segment only occurs in the images but without corresponding clinical symptoms,it would be called adjacent segment degeneration;if the corresponding clinical symptoms co-exist with degeneration in images,it would be called adjacent segment disease.Generally,the stress concentration on adjacent intervertebral discs and facet joints caused by spine fusion is the main pathogeny of adjacent segment degeneration and disease.The damage of normal spinal anatomy structure in surgery and the natural spine degeneration process are also important pathogenic factors.The occurrence of adjacent segment degeneration and disease after lumbar surgery is related to age,body weight,postoperative spinal-pelvic sagittal balance and the preoperative degeneration of adjacent segment.Surgical programs including numbers of the fusion segments,surgical approach and whether to adopt non-fusion technology have great effect on the occurrence of adjacent segment degeneration and disease.In the planning of surgeries,necessary measures and methods should be taken to prevent adjacent segment disease and degeneration according to the different patients.Non-fusion technology,minimally invasive spine surgery technique and Topping-off technique can help reduce the occurrence of adjacent segment disease and degenerative.If the patients are combined with high risk factors of adjacent segment degeneration and disease,more attention should be paid and appropriate and individualized therapies should be chosen.