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| Abstract |
Background. Controversy remains regarding the subsequent degeneration of adjacent segments, and little reliable information could be found in the literature regarding long-term clinical results and ad...jacent segment degeneration. The objective of this study is to investigate the degenerative change of adjacent segments to the fusion site and clinical outcome after posterolateral lumbar fusion with pedicle screw instrumentation and identify the risk factors in degenerative change at adjacent segments. Methods. Thirty-two patients who underwent posterolateral lumbar fusion and were able to be followed over four years were evaluated in this study. The intervertebral disc height, percent of slip, lumbosacral joint angle, lumbar lordosis and disc angle were all examined. The postoperative progression of degeneration at adjacent segments were defined as more than a 50 % narrowing in the adjacent disc height or more than a 5 % slip in adjacent segments in comparison to the preoperative neutral lateral radiographs. The clinical results were assessed using an evaluation scores for lumbar lesions proposed by the Japanese Orthopedic Association. Results. Fifteen (46.8%) of the 32 patients had adjacent segment degeneration including slip or narrowing. No significant correlation was found between the adjacent segment degeneration and the recovery rate at the final follow-up. In addition, no significant correlation was observed between the adjacent segment degeneration at the lastest follow-up and postoperative radiographic measurements. Conclusions. The rate of radiographic degeneration at the adjacent segments was 46. 8%. No significant correlation was found between degenerative change in the adjacent segments and the clinical results. We could not identify any preoperative radiographic factors which might have influenced the segments adjacent to the fusion.
腰椎後側方固定（以下PLF）術後の長期において，X線上の不安定性が見られ，隣接椎間障害が考えられる症例も少なくない．また固定隣接椎間障害の長期成績について様々な報告があるが，いまだに議論されているところである．pedicle screw を併用してPLF を行った症例のうち，４年以上経過観察可能であった32 症例を対象とした．術前後と最終経過観察時の椎間板腔の高さ・％ slip，および術前のlumbosacral jointangle，腰椎前弯角，固定椎間のdisc angle を全例計測した．臨床症状の評価として術前後の腰痛疾患治療成績判定基準（JOA）を用いて検討した．32 例中15 例（46.8％）で隣接椎間のすべりや狭小化を認めた．隣接椎間障害の有無と最終経過観察時のJOA スコアー改善率の間に有意な相関関係は認められず，X 線上の隣接椎間の変性と臨床症状は相関関係がないと思われた．隣接椎間に影響を及ぼす因子について隣接椎間障害のある群とない群で検討を行ったが，術前単純X 線像としてとして固定椎間の% slip・lumbosacral jointangle・腰椎前弯角・disc angle について比較検討を行った結果，いずれの項目も有意な差は認められなかった．show more
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