Objective To observe the short-term clinical results of the adjacent segment degeneration after the implantation of Coflex system at the interspinous space of adjacent segment to lumbar fusion.Methods Fifty patients with grade Ⅲ disc (Thompson MRI classification) of adjacent segment to lunbar fusion were included and divided alternately into two groups according to the order of hospitalization from January to November 2009.Coflex system was implanted at the interspinous space of adjacent segment to lumbar fusion in 25 patients as Coflex group,the other 25 patients did not have any surgical treatment were as control group.The followed up time was 2 years. Visual analogue scale (VAS) score of low back pain,changes of disc height and motion range of adjacent segment to lumbar fusion on X-ray imaging were evaluated by independent sample t-test or paired samples t-test.Results There were 22 patients in Coflex group and 21 patients in control group were followed up 2 years post-operation.The difference of VAS score between two groups was no significance ( P ＞ 0.05 ).In Coflex group,the change of postoperative disc height was no significance (P ＞ O.05 ),but the motion range was significantly reduced to 47％ of the preoperative value ( t =7.99,P ＜ 0.05 ). In control group,the postoperative disc height decreased slightly,without significant difference to the preoperative value ( P ＞ 0.05 ). Between the two groups,no differences of the disc height and motion range were found before operation,but the differences of the disc height changes(t =6.7,P ＜ 0.05 ) and motion rang ( t =- 14.5,P ＜ 0.05 ) were significant in 2 years post-operation. No complications such as Coflex system loosen, immigration and spinal process fracture were occurred.Conclusions Coflex system can obviously limit the motion range and maintain the disc space height of adjacent segment to lumbar fusion,and prevent its degeneration in some degree.%目的 研究腰椎融合节段相邻退变节段棘突间置入动态稳定装置Coflex短期椎间隙退变进展情况及临床疗效.方法 选取2009年1至11月腰椎融合节段相邻椎间隙退变程度为Thompson分级Ⅲ级的50例患者作为研究对象,根据入院顺序,将患者交替分为Coflex组(25例)和对照组(25例).Coflex组患者融合节段相邻退变节段棘突间置入Coflex,对照组患者融合节段相邻退变节段未予任何处理.所有患者术后定期随访时间为2年,将术后2年的腰痛视觉模拟量表(VAS)评分、椎间隙高度和椎间隙活动度作为近期疗效的观察指标,与术前进行比较,评价Coflex对融合节段邻近椎间隙的影响.组间数据比较使用独立样本t检验,组内比较使用配对样本t检验.结果 获得术后2年随访的患者Coflex组22例,对照组21例,术后两组腰痛VAS评分差异无统计学意义(P＞0.05)；Coflex组术后椎间隙高度较术前无明显变化(P＞0.05),但椎间活动度明显减小,为术前的47％(t =7.99,P＜0.05)；术后2年对照组椎间隙高度较术前有轻微下降,但差异无统计学意义(P＞0.05).两组术前融合节段相邻退变间隙椎间高度和活动度差异无统计学意义(P＞0.05),术后2年两组椎间隙高度变化值(t=6.7)和椎间活动度(t=-14.5)相比较差异均具有统计学意义(P＜0.05).患者均无棘突骨折、Coflex松动、脱落等并发症发生.结论 棘突间动态稳定装置Coflex能明显限制椎间隙的屈伸活动范围和维持相应节段的椎间隙高度,对融合节段相邻椎间隙退变具有一定的预防作用.
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