A modified method to treat severe asymptomatic pre‐existing degeneration of adjacent segment: a retrospective case‐control study

摘要

Pre-existing degeneration of adjacent segment is an important risk factor for adjacent-segment degeneration (ASD), but only limited and controversial studies have addressed its management. We retrospectively analyzed patients with symptomatic degeneration of the L5/S1 segment warranting surgical interference and severe asymptomatic degeneration of the L4/5 segment. Of these patients, those who underwent interbody fusion of the causative (L5/S1) segment and distraction of the intervertebral space and facet fusion of the adjacent L4/5 segment were included in Group A (n?=?103), while those who underwent interbody fusion of both the L5/S1 and L4/5 segments were included in Group B (n?=?81). Clinical and radiographic outcomes were evaluated. Mean follow-up time was 58.5 months (range, 48–75 months). We found no significant difference in clinical outcomes or incidence of ASD in the L3/4 segment between Groups A and B. Compared with Group B, Group A experienced less bleeding (315?±?84 ml vs. 532?±?105 ml), shorter operation time (107?±?34?min vs. 158?±?55?min) and lower costs (US $13,830 ± $2640 vs. US $16,020 ± $3380; P??0.05). In Group A, the disc height ratio (DHR) of the L4/5 segment was significantly increased from a preoperative value of 0.40?±?0.13 to a last–follow-up value of 0.53?±?0.18 (P??0.05), while the degree of canal stenosis (DCS) was decreased from a preoperative value of 34.3?±?11.2% to a last–follow-up value of 15.9?±?9.3?% (P??0.05). This modified method could be effective in treating severe asymptomatic pre-existing degeneration of adjacent segment in the lumbar spine.