Nonlinear Effect of Preexisting Cranial Adjacent Disc Degeneration on Cumulative 12-Year Revision Risk Following Lumbar Fusions.

IF 2.6 2区 医学 Q2 CLINICAL NEUROLOGY
Spine Pub Date : 2024-11-15 Epub Date: 2024-02-02 DOI:10.1097/BRS.0000000000004949
Leevi A Toivonen, Heikki Mäntymäki, Lorin M Benneker, Hannu Kautiainen, Arja Häkkinen, Marko H Neva
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引用次数: 0

Abstract

Study design: Retrospective analysis of prospectively collected data.

Objective: To evaluate how preexisting adjacent segment degeneration status impacts revision risk for adjacent segment disease (ASD) after lumbar fusions.

Summary of background data: ASD incurs late reoperations after lumbar fusion surgeries. ASD pathogenesis is multifactorial. Preexisting adjacent segment degeneration, measured by Pfirrmann, is suggested as one of the predisposing factors. We sought to find deeper insights into this association by using a more granular degeneration measure, the combined imaging score (CIS).

Patients and methods: A total of 197 consecutive lumbar fusions for degenerative pathologies were enrolled in a prospective follow-up (median: 12 yr). Preoperative cranial adjacent segment degeneration status was determined using Pfirrmann and CIS, which utilize both radiographs and magnetic resonance imaging. On the basis of CIS, patients were trichotomized into tertiles (CIS <7, CIS 7-10, and CIS >10). The cumulative ASD revision risk was determined for each tertile. After adjusting for age, sex, body mass index, sacral fixation, and fusion length, hazard ratios (95% CI) for ASD revisions were determined for each Pfirrmann and CIS score.

Results: Patients in the intermediate CIS tertile had a cumulative ASD revision risk of 25.4% (17.0%-37.0%), while both milder degeneration (CIS <7) [13.2% (6.5%-25.8%)] and end-stage degeneration (CIS >10) [13.6% (7.0%-25.5%)] appeared to be protective against surgical ASD. Pfirrmann failed to show a significant association with ASD revision risk. Adjusted analysis of CIS suggested increased ASD revisions after CIS 7, which turned contrariwise after CIS 10.

Conclusions: The effect of preexisting adjacent segment degeneration on ASD reoperation risk is not linear. The risk appears to increase with advancing degeneration but diminishes with end-stage degeneration. Therefore, end-stage degenerative segments may be considered to be excluded from fusion constructs.

Level of evidence: Therapeutic 3.

颅骨邻近椎间盘退变对腰椎融合术后 12 年累计翻修风险的非线性影响。
研究设计对前瞻性收集的数据进行回顾性分析:目的:评估先前存在的邻近节段退变状况如何影响腰椎融合术后邻近节段疾病(ASD)的翻修风险:背景数据摘要:腰椎融合手术后,邻近节段疾病会导致晚期再次手术。ASD的发病机制是多因素的。根据 Pfirrmann 测量,先前存在的邻近节段退变被认为是诱发因素之一。我们试图通过一种更精细的退变测量方法--联合成像评分(CIS)来深入了解这种关联:方法:我们对 197 例因退行性病变而连续进行腰椎融合术的患者进行了前瞻性随访(中位数为 12 年)。术前颅骨邻近节段的退变状况由 Pfirrmann 和 CIS 确定,CIS 同时使用了射线照相和磁共振成像。根据 CIS 将患者分为三等分(CIS 10)。每个三等分组的累积 ASD 修复风险均已确定。在对年龄、性别、体重指数、骶骨固定和融合长度进行调整后,确定了每个Pfirrmann和CIS评分的ASD翻修危险比(95%置信区间,CI):结果:CIS中级三等分患者的累积ASD翻修风险为25.4%(17.0%至37.0%),而轻度退变(CIS 10)[13.6%(7.0%至25.5%)]似乎对手术ASD有保护作用。Pfirrmann未能显示与ASD翻修风险有显著关联。对CIS的调整分析表明,CIS 7后ASD翻修率增加,而CIS 10后则相反:结论:先前存在的邻近节段退变对ASD再手术风险的影响不是线性的。结论:前期邻近节段退变对ASD再手术风险的影响不是线性的,风险似乎随着退变的进展而增加,但随着退变的终末期而降低。因此,可考虑将终末期退变节段排除在融合结构之外:证据等级:治疗 III 级。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Spine
Spine 医学-临床神经学
CiteScore
5.90
自引率
6.70%
发文量
361
审稿时长
6.0 months
期刊介绍: Lippincott Williams & Wilkins is a leading international publisher of professional health information for physicians, nurses, specialized clinicians and students. For a complete listing of titles currently published by Lippincott Williams & Wilkins and detailed information about print, online, and other offerings, please visit the LWW Online Store. Recognized internationally as the leading journal in its field, Spine is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of Spine. It is the leading subspecialty journal for the treatment of spinal disorders. Only original papers are considered for publication with the understanding that they are contributed solely to Spine. The Journal does not publish articles reporting material that has been reported at length elsewhere.
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