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Surgical treatment of adjacent instability after lumbar spine fusion.

机译：腰椎融合术后邻近不稳定性的外科治疗。

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STUDY DESIGN: This study is a retrospective review of 39 patients with previous instrumented lumbar fusion who underwent secondary spine surgery for lumbar adjacent instability. To the authors' knowledge, this is the largest study of surgical treatment of lumbar adjacent instability in the literature to date. OBJECT: This study evaluated the feasibility of adjacent instability treated with medial facetectomy, fusion with autologous bone grafting, and pedicle screw instrumentation. SUMMARY OF BACKGROUND DATA: The surgical treatment of adjacent instability has seldom been discussed. Revision spine fusions are challenged by high pseudarthrosis rates. METHODS: Thirty-nine patients with previous lumbar fusion underwent second lumbar spine surgery for adjacent instability. All were treated with autogenous posterolateral arthrodesis and transpedicle screw fixation in addition to decompressive laminectomy. Medical records, radiographs, and pain scores were obtained. RESULTS: The clinical results were excellent or good in 76.9% of patients, and the radiographic fusion was successful in 37 (94.9%) of patients. Flat back was noted in 8 (20.5%) of patients. In 5 patients (12.8%), neighboring segment breakdown again developed, and 2 of those patients underwent a third lumbar fusion. Dural tear during operation occurred in 2 patients. One patient experienced cauda equina syndrome but recovered bladder function 1 month later. CONCLUSION: Autogenous posterolateral arthrodesis combined with pedicle screw fixation led to successful radiologic and clinical outcome in patients with lumbar adjacent instability. Adequate decompression of the adjacent stenosis requires medial facetectomy, thus preventing aggressive nerve root manipulation and reducing the incidence of dural tear.
机译：研究设计：这项研究是对39例先前进行过腰椎融合术的患者进行的回顾性研究，这些患者因腰椎邻近不稳而接受了第二次脊柱手术。据作者所知，这是迄今为止有关腰椎邻近不稳手术治疗的最大文献。目的：本研究评估了内侧小平面切除术，自体植骨融合术和椎弓根螺钉器械治疗邻近不稳定性的可行性。背景资料摘要：很少讨论邻近不稳定性的手术治疗。修订脊柱融合术受到假性关节病高发的挑战。方法：39例先前有腰椎融合术的患者因邻近不稳定而接受了第二次腰椎手术。除减压椎板切除术外，所有患者均接受自体后外侧关节固定和经椎弓根螺钉固定。获得了病历，射线照相和疼痛评分。结果：76.9％的患者的临床结果优良或良好，并且37例（94.9％）的放射学融合成功。在8（20.5％）位患者中发现了后背平坦。在5例患者中（12.8％），周围节段再次破裂，其中2例患者进行了第三次腰椎融合术。手术中出现硬膜撕裂2例。一名患者出现马尾综合症，但在1个月后恢复了膀胱功能。结论：自体后外侧关节固定结合椎弓根螺钉固定术可成功治疗腰椎邻近不稳患者的放射学和临床疗效。相邻狭窄的充分减压需要内侧小平面切除术，从而防止了神经根的主动操作并降低了硬膜撕裂的发生率。

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