• 解放軍總醫(yī)院第一附屬醫(yī)院骨科 全軍骨科研究所（北京，100048）;

目的 對腰椎融合術(shù)后出現(xiàn)鄰近節(jié)段退變（adjacent segment degeneration，ASD）的臨床研究現(xiàn)狀進(jìn)行綜述。 方法查閱近年關(guān)于腰椎融合術(shù)后出現(xiàn)ASD的概念、發(fā)生率、相關(guān)影響因素和預(yù)防等方面的文獻(xiàn)，并進(jìn)行綜述。 結(jié)果ASD的概念包括影像學(xué)ASD和臨床癥狀A(yù)SD，腰椎融合術(shù)后影像學(xué)ASD發(fā)生率可達(dá)8%～100%，臨床癥狀A(yù)SD發(fā)生率為5.2%～18.5%。 ASD的發(fā)生與個體因素（年齡、性別、術(shù)前情況等）和手術(shù)因素（融合節(jié)段長短、融合術(shù)式、內(nèi)固定使用、矢狀面平衡、椎間隙過度撐開等）相關(guān)。術(shù)中減少融合節(jié)段、維持矢狀面平衡以及非融合技術(shù)的應(yīng)用可預(yù)防ASD的發(fā)生。結(jié)論腰椎融合術(shù)后ASD發(fā)生率增高。非融合技術(shù)的應(yīng)用降低了ASD的發(fā)生率，取得了較好的近期臨床效果，但也存在一些并發(fā)癥，其中長期效果尚待進(jìn)一步研究。

引用本文： 雙峰,侯樹勛. 腰椎融合術(shù)后鄰近節(jié)段退變的臨床研究現(xiàn)狀. 中國修復(fù)重建外科雜志, 2013, 27(1): 110-115. doi: 復(fù)制

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1. Cheh G, Bridwell KH, Lenke LG, et al. Adjacent segment disease followinglumbar/thoracolumbar fusion with pedicle screw instrumentation: a minimum 5-year follow-up. Spine (Phila Pa 1976), 2007, 32(20): 2253-2257.
2. Bambakidis NC, Feiz-Erfan I, Klopfenstein JD, et al. Indications for surgical fusion of the cervical and lumbar motion segment. Spine (Phila Pa 1976), 2005, 30(16 Suppl): S2-S6.
3. Resnick DK, Choudhri TF, Dailey AT, et al. Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 5: correlation between radiographic and functional outcome. J Neurosurg Spine, 2005, 2(6): 658-661.
4. Stoffel M, Behr M, Reinke A, et al. Pedicle screw-based dynamic stabilization of the thoracolumbar spine with the Cosmic-system: a prospective observation. Acta Neurochir (Wien), 2010, 152(5): 835-843.
5. Min JH, Jang JS, Jung B, et al. The clinical characteristics and risk factors for the adjacent segment degeneration in instrumented lumbar fusion. J Spinal Disord Tech, 2008, 21(5): 305-309.
6. Park JY, Chin DK, Cho YE. Accelerated L5-S1 segment degeneration after spinal fusion on and above L4-5: minimum 4-year Follow-up results. J Korean Neurosurg Soc, 2009, 45(2): 81-84.
7. Harrop JS, Youssef JA, Maltenfort M, et al. Lumbar adjacent segment degeneration and disease after arthrodesis and total disc arthroplasty. Spine (Phila Pa 1976), 2008, 33(15): 1701-1707.
8. Hilibrand AS, Robbins M. Adjacent segment degeneration and adjacent segment disease: the consequences of spinal fusion? Spine J, 2004, 4(6 Suppl): 190S-194S.
9. Kim JH, Kim SS, Suk SI. Incidence of proximal adjacent failure in adult lumbar deformity correction based on proximal fusion level. Asian Spine J, 2007, 1(1): 19-26.
10. Lee CS, Hwang CJ, Lee SW, et al. Risk factors for adjacent segment disease after lumbar fusion. Eur Spine J, 2009, 18(11): 1637-1643.
11. Park P, Garton HJ, Gala VC, et al. Adjacent segment disease after lumbar or lumbosacral fusion: review of the literature. Spine (Phila Pa 1976), 2004, 29(17): 1938-1944.
12. Kaito T, Hosono N, Mukai Y, et al. Induction of early degeneration of the adjacent segment after posterior lumbar interbody fusion by excessive distraction of lumbar disc space. J Neurosurg Spine, 2010, 12(6): 671-679.
13. Kaito T, Hosono N, Fuji T, et al. Disc space distraction is a potent risk factor for adjacent disc disease after PLIF. Arch Orthop Trauma Surg, 2011, 131(11): 1499-1507.
14. Hikata T, Kamata M, Furukawa M. Risk factors for adjacent segment disease after posterior lumbar interbody fusion and efficacy of simultaneous decompression surgery for symptomatic adjacent segment disease. J Spinal Disord Tech, 2012. [Epub ahead of print].
15. Ghiselli G, Wang JC, Bhatia NN, et al. Adjacent segment degeneration in the lumbar spine. J Bone Joint Surg (Am), 2004, 86-A(7): 1497-1503.
16. Seitsalo S, Schlenzka D, Poussa M, et al. Disc degeneration in young patients with isthmic spondylolisthesis treated operatively or conservatively: a long-term follow-up. Eur Spine J, 1997, 6(6): 393-397.
17. Wai EK, Santos ER, Morcom RA, et al. Magnetic resonance imaging 20 years after anterior lumbar interbody fusion. Spine (Phila Pa 1976), 2006, 31(17): 1952-1956.
18. Fan SW, Zhou ZJ, Hu ZJ, et al. Quantitative MRI analysis of the surface area, signal intensity and MRI index of the central bright area for the evaluation of early adjacent disc degeneration after lumbar fusion. Eur Spine J, 2012, 21(9): 1709-1715.
19. Kumar MN, Jacquot F, Hall H. Long-term follow-up of functional outcomes and radiographic changes at adjacent levels following lumbar spine fusion for degenerative disc disease. Eur Spine J, 2001, 10(4): 309-313.
20. Ekman P, Möller H, Shalabi A, et al. A prospective randomised study on the long-term effect of lumbar fusion on adjacent disc degeneration. Eur Spine J, 2009, 18(8): 1175-1186.
21. 李淳德, 于崢嶸, 劉憲義, 等. 腰椎內(nèi)固定融合術(shù)后鄰近節(jié)段退變的影響因素. 中華外科雜志, 2006, 44(4): 246-248.
22. Ma J, Fan S, Zhao F. Intraoperative malposition of pedicle probe or screws: a potential cause of the acceleration of degeneration in superior adjacent intervertebral disc. Med Hypotheses, 2011, 77(6): 1102-1104.
23. Aota Y, Kumano K, Hirabayashi S. Postfusion instability at the adjacent segments after rigid pedicle screw fixation for degenerative lumbar spinal disorders. J Spinal Disord, 1995, 8(6): 464-473.
24. Cho KS, Kang SG, Yoo DS, et al. Risk factors and surgical treatment for symptomatic adjacent segment degeneration after lumbar spine fusion. J Korean Neurosurg Soc, 2009, 46(5): 425-430.
25. Videbaek TS, Egund N, Christensen FB, et al. Adjacent segment degeneration after lumbar spinal fusion: the impact of anterior column support: a randomized clinical trial with an eight- to thirteen-year magnetic resonance imaging follow-up. Spine (Phila Pa 1976), 2010, 35(22): 1955-1964.
26. Chou WY, Hsu CJ, Chang WN, et al. Adjacent segment degeneration after lumbar spinal posterolateral fusion with instrumentation in elderly patients. Arch Orthop Trauma Surg, 2002, 122(1): 39-43.
27. Anandjiwala J, Seo JY, Ha KY, et al. Adjacent segment degeneration after instrumented posterolateral lumbar fusion: a prospective cohort study with a minimum five-year follow-up. Eur Spine J, 2011, 20(11): 1951-1960.
28. Kim KH, Lee SH, Shim CS, et al. Adjacent segment disease after interbody fusion and pedicle screw fixations for isolated L4-L5 spondylolisthesis: A minimum five-year follow-up. Spine (Phila Pa 1976), 2010. [Epub ahead of print].
29. Kumar MN, Baklanov A, Chopin D. Correlation between sagittal plane changes and adjacent segment degeneration following lumbar spine fusion. Eur Spine J, 2001, 10(4): 314-319.
30. Etebar S, Cahill DW. Risk factors for adjacent- segment failure following lumbar fixation with rigid instrumentation for degenerative instability. J Neurosurg, 1999, 90(Suppl 2): 163-169.
31. Cohn EL, Maurer EJ, Keats TE, et al. Plain film evaluation of degenerative disk disease at the lumbosacral junction. Skeletal Radiol, 1997, 26(3): 161-166.
32. Pfirrmann CW, Metzdorf A, Zanetti M, et al. Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine (Phila Pa 1976), 2001, 26(17): 1873-1878.
33. 劉則征, 張忠民, 金大地. 腰椎融合內(nèi)固定術(shù)后鄰近節(jié)段退變的影響因素. 南方醫(yī)科大學(xué)學(xué)報, 2010, 30(5): 1134-1137.
34. Lai PL, Chen LH, Niu CC, et al. Relation between laminectomy and development of adjacent segment instability after lumbar fusion with pedicle fixation. Spine (Phila Pa 1976), 2004, 29(22): 2527-2532.
35. Liao JC, Chen WJ, Chen LH, et al. Outcome of the L5-S1 segment after posterior instrumented spinal surgery in degenerative lumbar diseases. Chang Gung Med J, 2009, 32(1): 81-88.
36. Turunen V, Nyyssönen T, Miettinen H, et al. Lumbar instrumented posterolateral fusion in spondylolisthetic and failed back patients: a long-term follow-up study spanning 11-13 years. Eur Spine J, 2012, 21(11): 2140-2148.
37. Korovessis P, Repantis T, Zacharatos S, et al. Does Wallis implant reduce adjacent segment degeneration above lumbosacral instrumented fusion? Eur Spine J, 2009, 18(6): 830-840.
38. Liu CL, Zhong ZC, Shih SL, et al. Influence of Dynesys system screw profile on adjacent segment and screw. J Spinal Disord Tech, 2010, 23(6): 410-417.
39. Sénégas J, Vital JM, Pointillart V, et al. Clinical evaluation of a lumbar interspinous dynamic stabilization device (the Wallis system) with a 13-year mean follow-up. Neurosurg Rev, 2009, 32(3): 335-342.
40. Stoll TM, Dubois G, Schwarzenbach O. The dynamic neutralization system for the spine: a multi-center study of a novel non-fusion system. Eur Spine J, 2002, 11 Suppl 2: S170-178.
41. 丁亮華, 何雙華, 樊友亮, 等. 椎管減壓椎弓根動態(tài)穩(wěn)定系統(tǒng)(Dynesys)治療腰椎管狹窄癥的臨床療效. 中國脊柱脊髓雜志, 2011, 21(8): 633-638.
42. Palmer DK, Inceoglu S, Cheng WK. Stem fracture after total facet replacement in the lumbar spine: a report of two cases and review of the literature. Spine J, 2011, 11(7): e15-19.
43. Phillips FM, Tzermiadianos MN, Voronov LI, et al. Effect of the Total Facet Arthroplasty System after complete laminectomy-facetectomy on the biomechanics of implanted and adjacent segments. Spine J, 2009, 9(1): 96-102.
  1. 1. Cheh G, Bridwell KH, Lenke LG, et al. Adjacent segment disease followinglumbar/thoracolumbar fusion with pedicle screw instrumentation: a minimum 5-year follow-up. Spine (Phila Pa 1976), 2007, 32(20): 2253-2257.
  2. 2. Bambakidis NC, Feiz-Erfan I, Klopfenstein JD, et al. Indications for surgical fusion of the cervical and lumbar motion segment. Spine (Phila Pa 1976), 2005, 30(16 Suppl): S2-S6.
  3. 3. Resnick DK, Choudhri TF, Dailey AT, et al. Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 5: correlation between radiographic and functional outcome. J Neurosurg Spine, 2005, 2(6): 658-661.
  4. 4. Stoffel M, Behr M, Reinke A, et al. Pedicle screw-based dynamic stabilization of the thoracolumbar spine with the Cosmic-system: a prospective observation. Acta Neurochir (Wien), 2010, 152(5): 835-843.
  5. 5. Min JH, Jang JS, Jung B, et al. The clinical characteristics and risk factors for the adjacent segment degeneration in instrumented lumbar fusion. J Spinal Disord Tech, 2008, 21(5): 305-309.
  6. 6. Park JY, Chin DK, Cho YE. Accelerated L5-S1 segment degeneration after spinal fusion on and above L4-5: minimum 4-year Follow-up results. J Korean Neurosurg Soc, 2009, 45(2): 81-84.
  7. 7. Harrop JS, Youssef JA, Maltenfort M, et al. Lumbar adjacent segment degeneration and disease after arthrodesis and total disc arthroplasty. Spine (Phila Pa 1976), 2008, 33(15): 1701-1707.
  8. 8. Hilibrand AS, Robbins M. Adjacent segment degeneration and adjacent segment disease: the consequences of spinal fusion? Spine J, 2004, 4(6 Suppl): 190S-194S.
  9. 9. Kim JH, Kim SS, Suk SI. Incidence of proximal adjacent failure in adult lumbar deformity correction based on proximal fusion level. Asian Spine J, 2007, 1(1): 19-26.
  10. 10. Lee CS, Hwang CJ, Lee SW, et al. Risk factors for adjacent segment disease after lumbar fusion. Eur Spine J, 2009, 18(11): 1637-1643.
  11. 11. Park P, Garton HJ, Gala VC, et al. Adjacent segment disease after lumbar or lumbosacral fusion: review of the literature. Spine (Phila Pa 1976), 2004, 29(17): 1938-1944.
  12. 12. Kaito T, Hosono N, Mukai Y, et al. Induction of early degeneration of the adjacent segment after posterior lumbar interbody fusion by excessive distraction of lumbar disc space. J Neurosurg Spine, 2010, 12(6): 671-679.
  13. 13. Kaito T, Hosono N, Fuji T, et al. Disc space distraction is a potent risk factor for adjacent disc disease after PLIF. Arch Orthop Trauma Surg, 2011, 131(11): 1499-1507.
  14. 14. Hikata T, Kamata M, Furukawa M. Risk factors for adjacent segment disease after posterior lumbar interbody fusion and efficacy of simultaneous decompression surgery for symptomatic adjacent segment disease. J Spinal Disord Tech, 2012. [Epub ahead of print].
  15. 15. Ghiselli G, Wang JC, Bhatia NN, et al. Adjacent segment degeneration in the lumbar spine. J Bone Joint Surg (Am), 2004, 86-A(7): 1497-1503.
  16. 16. Seitsalo S, Schlenzka D, Poussa M, et al. Disc degeneration in young patients with isthmic spondylolisthesis treated operatively or conservatively: a long-term follow-up. Eur Spine J, 1997, 6(6): 393-397.
  17. 17. Wai EK, Santos ER, Morcom RA, et al. Magnetic resonance imaging 20 years after anterior lumbar interbody fusion. Spine (Phila Pa 1976), 2006, 31(17): 1952-1956.
  18. 18. Fan SW, Zhou ZJ, Hu ZJ, et al. Quantitative MRI analysis of the surface area, signal intensity and MRI index of the central bright area for the evaluation of early adjacent disc degeneration after lumbar fusion. Eur Spine J, 2012, 21(9): 1709-1715.
  19. 19. Kumar MN, Jacquot F, Hall H. Long-term follow-up of functional outcomes and radiographic changes at adjacent levels following lumbar spine fusion for degenerative disc disease. Eur Spine J, 2001, 10(4): 309-313.
  20. 20. Ekman P, Möller H, Shalabi A, et al. A prospective randomised study on the long-term effect of lumbar fusion on adjacent disc degeneration. Eur Spine J, 2009, 18(8): 1175-1186.
  21. 21. 李淳德, 于崢嶸, 劉憲義, 等. 腰椎內(nèi)固定融合術(shù)后鄰近節(jié)段退變的影響因素. 中華外科雜志, 2006, 44(4): 246-248.
  22. 22. Ma J, Fan S, Zhao F. Intraoperative malposition of pedicle probe or screws: a potential cause of the acceleration of degeneration in superior adjacent intervertebral disc. Med Hypotheses, 2011, 77(6): 1102-1104.
  23. 23. Aota Y, Kumano K, Hirabayashi S. Postfusion instability at the adjacent segments after rigid pedicle screw fixation for degenerative lumbar spinal disorders. J Spinal Disord, 1995, 8(6): 464-473.
  24. 24. Cho KS, Kang SG, Yoo DS, et al. Risk factors and surgical treatment for symptomatic adjacent segment degeneration after lumbar spine fusion. J Korean Neurosurg Soc, 2009, 46(5): 425-430.
  25. 25. Videbaek TS, Egund N, Christensen FB, et al. Adjacent segment degeneration after lumbar spinal fusion: the impact of anterior column support: a randomized clinical trial with an eight- to thirteen-year magnetic resonance imaging follow-up. Spine (Phila Pa 1976), 2010, 35(22): 1955-1964.
  26. 26. Chou WY, Hsu CJ, Chang WN, et al. Adjacent segment degeneration after lumbar spinal posterolateral fusion with instrumentation in elderly patients. Arch Orthop Trauma Surg, 2002, 122(1): 39-43.
  27. 27. Anandjiwala J, Seo JY, Ha KY, et al. Adjacent segment degeneration after instrumented posterolateral lumbar fusion: a prospective cohort study with a minimum five-year follow-up. Eur Spine J, 2011, 20(11): 1951-1960.
  28. 28. Kim KH, Lee SH, Shim CS, et al. Adjacent segment disease after interbody fusion and pedicle screw fixations for isolated L4-L5 spondylolisthesis: A minimum five-year follow-up. Spine (Phila Pa 1976), 2010. [Epub ahead of print].
  29. 29. Kumar MN, Baklanov A, Chopin D. Correlation between sagittal plane changes and adjacent segment degeneration following lumbar spine fusion. Eur Spine J, 2001, 10(4): 314-319.
  30. 30. Etebar S, Cahill DW. Risk factors for adjacent- segment failure following lumbar fixation with rigid instrumentation for degenerative instability. J Neurosurg, 1999, 90(Suppl 2): 163-169.
  31. 31. Cohn EL, Maurer EJ, Keats TE, et al. Plain film evaluation of degenerative disk disease at the lumbosacral junction. Skeletal Radiol, 1997, 26(3): 161-166.
  32. 32. Pfirrmann CW, Metzdorf A, Zanetti M, et al. Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine (Phila Pa 1976), 2001, 26(17): 1873-1878.
  33. 33. 劉則征, 張忠民, 金大地. 腰椎融合內(nèi)固定術(shù)后鄰近節(jié)段退變的影響因素. 南方醫(yī)科大學(xué)學(xué)報, 2010, 30(5): 1134-1137.
  34. 34. Lai PL, Chen LH, Niu CC, et al. Relation between laminectomy and development of adjacent segment instability after lumbar fusion with pedicle fixation. Spine (Phila Pa 1976), 2004, 29(22): 2527-2532.
  35. 35. Liao JC, Chen WJ, Chen LH, et al. Outcome of the L5-S1 segment after posterior instrumented spinal surgery in degenerative lumbar diseases. Chang Gung Med J, 2009, 32(1): 81-88.
  36. 36. Turunen V, Nyyssönen T, Miettinen H, et al. Lumbar instrumented posterolateral fusion in spondylolisthetic and failed back patients: a long-term follow-up study spanning 11-13 years. Eur Spine J, 2012, 21(11): 2140-2148.
  37. 37. Korovessis P, Repantis T, Zacharatos S, et al. Does Wallis implant reduce adjacent segment degeneration above lumbosacral instrumented fusion? Eur Spine J, 2009, 18(6): 830-840.
  38. 38. Liu CL, Zhong ZC, Shih SL, et al. Influence of Dynesys system screw profile on adjacent segment and screw. J Spinal Disord Tech, 2010, 23(6): 410-417.
  39. 39. Sénégas J, Vital JM, Pointillart V, et al. Clinical evaluation of a lumbar interspinous dynamic stabilization device (the Wallis system) with a 13-year mean follow-up. Neurosurg Rev, 2009, 32(3): 335-342.
  40. 40. Stoll TM, Dubois G, Schwarzenbach O. The dynamic neutralization system for the spine: a multi-center study of a novel non-fusion system. Eur Spine J, 2002, 11 Suppl 2: S170-178.
  41. 41. 丁亮華, 何雙華, 樊友亮, 等. 椎管減壓椎弓根動態(tài)穩(wěn)定系統(tǒng)(Dynesys)治療腰椎管狹窄癥的臨床療效. 中國脊柱脊髓雜志, 2011, 21(8): 633-638.
  42. 42. Palmer DK, Inceoglu S, Cheng WK. Stem fracture after total facet replacement in the lumbar spine: a report of two cases and review of the literature. Spine J, 2011, 11(7): e15-19.
  43. 43. Phillips FM, Tzermiadianos MN, Voronov LI, et al. Effect of the Total Facet Arthroplasty System after complete laminectomy-facetectomy on the biomechanics of implanted and adjacent segments. Spine J, 2009, 9(1): 96-102.