腰椎退变性侧凸患者椎间盘退行性变的影像学观测

目的:评价退变性腰椎侧凸患者椎间盘退变程度与腰椎侧凸角度、腰椎前凸角度的相关性.方法:本组共包括84例退变性腰椎侧凸患者(平均年龄为64.1±5.3岁),在X线片上测量其顶椎间盘(如顶椎为椎体则取该椎体下位椎间盘)及其相邻上下椎间盘(共252个椎间盘)的不对称指数,MRI T2加权像上测量椎问盘内髓核与脑脊液的平均相对信号强度.应用Spearmann相关性分析研究椎间盘不对称指数与腰椎侧凸角的相关性、平均相对信号强度与腰椎前凸角的相关性.结果:84例退变性腰椎侧凸患者中,凸侧三个椎间盘的高度平均为40.1±1.8mm:凹侧平均为38.3±1.1mm.凸凹侧椎同盘高度比较差异有显著性(P<.05).椎间盘不对称指数的平均值为0.042±0.018,经Spearman相关分析椎间盘不对称指数与侧凸Cobb角之间有明显正相关性(P<.05);T2加权像上退变性腰椎侧凸髓核平均相对信号强度Ⅰ级8例,Ⅱ级27例,Ⅲ级32例,Ⅳ级17例;经Spearman相关分析该平均相对信号强度与腰椎前凸Cobb角之间有相关性(P<.05).结论:退变性腰椎侧凸的侧凸角与椎间盘退变的不对称性程度存在正相关,腰椎前凸角减少与椎间盘退变程度有相关性.     

腰椎后路椎间融合(PLIF)固定矫形治疗症状性退变性腰椎侧凸

目的总结腰椎后路减压、椎间植骨融合(PLIF)手术治疗退变性腰椎侧凸的疗效及安全性。方法通过总结我科近五年治疗31例退变性脊柱侧凸患者,年龄56～77岁,平均63.7岁,其中男性14例,女性17例,随访12～24个月,平均15个月。术前评估包括详细体格检查,腰、腿痛VAS评分,ODI评分;影像学检查包括站立位腰椎正侧位片、腰椎MRI;所有患者均行腰椎后路减压,退变间隙椎间撑开、植骨、椎弓根螺钉内固定术,术后1、3、6、12个月随访,复查VAS、ODI及X线平片。结果术前腰、腿部VAS评分分别为6.5分和4.7分;ODI术前评分为57.7%;术前腰椎侧凸Cobb角平均为22.8°,腰椎生理前凸角为20.7°。末次随访腰、腿部VAS评分为3.3分和2.4分;ODI评分为30.3%;腰椎侧凸Cobb角平均为9.8°,腰椎生理前凸角为32.1°;以上差异均有统计学意义。未发生椎弓根螺钉断裂及松动,有7例相邻上位间隙进一步发生退变,但患者功能提高,未再手术;无神经瘫痪、深部感染及死亡等严重并发症。结论腰椎退变性侧凸经腰椎后路减压椎间融合矫形椎弓根螺钉内固定既可以矫正不对称性退变,又可以去除疼痛源,恢复腰椎生理前凸,具有手术相对安全、椎弓根螺钉固定牢固等优点,是提高患者功能的有效治疗方法。     

退变性腰椎侧凸的外科治疗

目的探讨退变性腰椎侧凸的特点、诊断与治疗。方法2001年7月至2004年1月手术治疗退变性脊柱侧凸患者15例,行后路彻底椎板减压、椎弓根钉棒矫形固定,椎间融合器融合12例,后外侧植骨融合3例,回顾性分析其临床特点、手术方法与效果。结果术后侧凸平均矫正率为42.8%,腰腿痛均消失,下肢麻木等症状减轻,随访6~36个月,植骨融合良好,无融合器移位,矫正度数与椎间隙高度无丢失。结论成人退变性腰椎侧凸发病年龄大,多合并腰椎管狭窄、失稳等,腰腿痛原因复杂,治疗的主要目的是彻底减压,通过矫形使脊柱重新获得稳定,椎弓根钉棒固定及椎间融合是有效的治疗方法。     

退变性腰椎侧凸病理基础及治疗

退变性腰椎侧凸是成年以后新出现的侧凸,常伴有多节段严重椎管狭窄、椎间盘突出、腰椎侧方滑脱和旋转半脱位,治疗上较单一的腰椎退变性疾病复杂。本文对其病理机制、临床特征和目前的治疗进展进行综述。     

侧路融合术治疗退变性腰椎侧凸的临床疗效分析

[目的]探讨侧路融合术治疗退变性腰椎侧凸的临床疗效。[方法]2012年3月~2014年6月退变性腰椎侧凸的患者28例,男17例,女11例;年龄55~71岁,平均(65.7±13.58)岁。采用侧路融合术Cross-Fuse假体置入。[结果]平均随访22个月(10~34个月),随访期间腰椎冠状面及矢状面序列矫正度数及椎间孔平均高度、椎间隙平均高度未见明显丢失,融合器无移位,未见假关节形成。末次随访腰痛及腿痛VAS评分、ODI功能障碍指数评分均较术前低,且差异均有统计学意义(P0.001),提示腰痛及腿痛等症状经手术治疗后有所改善。手术后腰椎冠状面及矢状面Cobb角较手术前有所降低,而术后腰椎侧方滑移度、椎间孔平均高度和椎间隙平均高度则有所提高,差异均有统计学意义(P0.001)。[结论]侧路融合术治疗退变性腰椎侧凸临床效果较好。     

椎旁肌退变对退变性腰椎侧凸短节段减压融合病人术后临床疗效的影响

目的分析椎旁肌退变程度对退变性腰椎侧凸短节段减压融合病人术后临床疗效的影响。方法退变性腰椎侧凸行短节段(≤3个节段)椎管减压椎体间融合治疗的病人53例,根据术前核磁共振是否存在椎旁肌退变分为观察组28例,对照组25例。比较两组术前术后腰椎Cob角、椎旁肌(竖脊肌、多裂肌、腰大肌)横截面积、椎旁肌脂肪化率、视觉模拟量表评分、Oswestry功能障碍指数。结果两组病人术前Cob角、VAS、ODI评分比较,差异无统计学意义(P0.05)。术后6个月两组病人Cob角与术前比较,差异有统计学意义(P0.05)。术后12个月观察组Cob角大于对照组,对照组VAS、ODI评分优于观察组,差异有统计学意义(P0.05)。观察组多裂肌和竖脊肌的凹侧横截面积与对照组比较,差异具有统计学意义(P0.05),观察组中凹侧和凸侧比较,多裂肌及竖脊肌横截面积比较差异有统计学意义(P0.05)。多裂肌脂肪化率与术后ODI评分存在显著相关性(r=0.462)。结论退变性腰椎侧凸病人术前应重视椎旁肌退变程度的评价,特别是多裂肌的脂肪化率,延长固定节段或注意加强腰背肌的锻炼,有助于缓解病人术后腰背痛。     

退变性腰椎侧凸现代概念及治疗策略

腰椎退变性疾病包括椎间盘退变所致椎间盘突出症、退变性腰椎椎管狭窄症、退变性椎滑脱症及退变性腰椎侧凸症。     

OLIF与TLIF手术治疗脊柱退变性侧凸的临床对比

目的 探讨经椎间孔腰椎椎体间融合术(transforaminal lumbar interbody fusion,TLIF)与斜外侧腰椎椎体间融合术(ob-lique lateral lumbar interbody fusion,OLIF)治疗脊柱退变性侧凸的疗效差异.方法 纳入2017年1月～2019年1月本院收治...     

退变性腰椎侧凸椎体终板Modic改变的分布情况及其影响因素

目的:观察退变性腰椎侧凸患者终板Modic改变的分布情况,分析其相关影响因素及与腰痛的关系。方法:回顾分析2000年3月～2009年3月我院收治的126例退变性腰椎侧凸患者的影像学资料,采用VAS对患者腰痛程度进行评估。观察患者终板Modic改变的发生率、类型及分布特点;比较存在Modic改变与不存在Modic改变患者的VAS评分;分析Modic改变与椎间盘退变、终板倾斜度、腰椎侧凸角及体重指数间的相关性。结果:126例患者756个腰椎间盘中,69例(54.8%)124(18.2%)个椎间盘邻近终板存在Modic改变。存在Modic改变患者VAS评分5.5±2.0,不存在Modic改变患者VAS评分3.0±1.5,两者比较差异有显著性(P<0.01)。Modic分型:Ⅰ型有15例患者(11.9%)19个椎间盘退变(2.5%),Ⅱ型48例(38.1%)97个椎间盘退变(12.8%),Ⅲ型6例(4.8%)8个椎间盘退变(1.1%)。退变终板节段:L5/S1椎间盘32个(25.8%),L4/5椎间盘26个(21.0%),L3/4椎间盘9个(7.3%),L2/3椎间盘47个(37.9%),L1/2椎间盘6个(4.8%),T12/L1椎间盘4个(3.2%)。Modic改变发生于终板凹侧99(13.1%)个,发生于终板凸侧25(3.3%)个;凹侧与凸侧发生率比较差异有显著性(P<0.01)。Modic改变与椎间盘退变、终板倾斜度、腰椎侧凸角及体重指数存在显著相关性(P<0.05)。结论:Modic改变与椎间盘退变、终板倾斜度、腰椎侧凸角及体重指数之间存在相关关系;Modic改变以Ⅱ型多见,多发生于终板的凹侧,以L2/3、L5/S1和L4/5节段多发。     

退变性腰椎侧凸患者椎旁肌退变与术后近端交界性后凸的相关性研究

目的:探讨退变性腰椎侧凸(degenerative lumbar scoliosis,DLS)患者术前腰椎椎旁肌肉的退变程度与后路长节段固定融合术后近端交界性后凸(proximal junctional kyphosis,PJK)发生的关系。方法:本研究共纳入52例DLS患者,根据末次随访是否发生PJK分为PJK组(10例)及无PJK(non-PJK)组(42例)。影像学评估包括脊柱骨盆矢状位参数、腰椎椎旁肌肌量(肌肉与椎体/椎间盘横截面积比值)以及肌肉-脂肪指数(肌肉与皮下脂肪的平均信号强度之比)。利用Logistic回归分析PJK发生的危险因素。比较两组患者一般资料、术前及随访时腰痛VAS及健康相关生活质量评分(SRS-22)。结果:本组患者PJK发生率为19.23%。患者手术年龄、性别、身体质量指数、患病时长、糖尿病、截骨及椎间融合、固定节段数、减压节段数、骨密度T值在PJK组及无PJK组均未见明显统计学差异。术前骨矿盐密度(bone mineral density,BMD)较低、术前胸腰段后凸角(TLK)较大、术中胸椎后凸角(TK)矫正过大、最上端固定椎(UIV)位于T12-L1、术后即刻交界性后凸角(PJA)过大、术前骶骨倾斜角(SS)较小、术后PJA变化值较大、腰背伸肌群脂肪退变明显可能与腰椎退变性侧凸长节段固定术后发生PJK相关。通过Logistic回归分析发现,术前SS25°(OR=12.902,P=0.046)、术后即刻PJA增大≥3.6°(OR=21.940,P=0.015)、腰背伸肌肌肉-脂肪指数≥27.65(OR=11.749,P=0.019)为发生PJK的独立危险因素。PJK患者的随访腰痛VAS及SRS-22功能状态评分较non-PJK组差。结论:DLS术后发生PJK患者,术前腰椎椎旁肌肌量较低、脂肪退变明显。术前SS25°、术后即刻PJA增大≥3.6°、腰背伸肌肌肉-脂肪指数≥27.65为发生PJK的独立危险因素。     

Morphometric analysis of the lumbar intervertebral foramen in patients with degenerative lumbar scoliosis by multidetector-row computed tomography

Purpose

How the lumbar neural foramina are affected by segmental deformities in patients in whom degenerative lumbar scoliosis (DLS) is unknown. Here, we used multidetector-row computed tomography (MDCT) to measure the morphology of the foramina in three dimensions, which allowed us to elucidate the relationships between foraminal morphology and segmental deformities in DLS.

Methods

In 77 DLS patients (mean age, 69.4) and 19 controls (mean age, 69), the foraminal height (FH), foraminal width (FW), posterior disc height (PDH), interval between the pedicle and superior articular process (P-SAP), and cross-sectional foraminal area (FA) were measured on reconstructed MDCT data, using image-editing software, at the entrance, minimum-area point, and exit of each foramen. The parameters of segmental deformity included the intervertebral wedging angle and anteroposterior and lateral translation rate, measured on radiographs, and the vertebral rotation angle, measured using reconstructed MDCT images.

Results

The FH, PDH, P-SAP, and FA were smaller at lower lumbar levels and on the concave side of intervertebral wedging (p < 0.05). In the DLS patients, the FH, P-SAP, and FA were significantly smaller than for the control group at all three foraminal locations and every lumbar level (p < 0.05). Intervertebral wedging strongly decreased the FA of the concave side (p < 0.05). Anteroposterior translation caused the greatest reduction in P-SAP (p < 0.05). Vertebral rotation decreased the P-SAP and FA at the minimum-area point on the same side as the rotation (p < 0.05).

Conclusion

The new analysis method proposed here is useful for understanding the pathomechanisms of foraminal stenosis in DLS patients.     

退变性腰椎侧凸患者腹主动脉与腰椎椎体相对位置的影像学测量

目的:探讨退变性腰椎侧凸(degenerative lumbar scoliosis,DLS)患者腰椎左侧凸和右侧凸情况下,腹主动脉与腰椎椎体的解剖关系。方法:回顾性分析我院2015年1月～2018年6月142例DLS患者和132例无脊柱侧凸的正常人群(对照组),DLS患者包含80例左侧凸患者(左侧凸组)和62例右侧凸患者(右侧凸组),观察对象均处于矢状位平衡,两组在性别、年龄和体重指数(body mass index,BMI)上与对照组匹配。通过X线片测量DLS患者腰椎侧凸方向、Cobb角、顶椎位置及冠状位偏移距离;通过MRI T1加权像建立笛卡尔坐标系,测量主动脉-椎体角度(α)、旋转角度(γ)、主动脉-椎体距离(d)及主动脉后壁-椎体前缘间隙(Int)。α、γ、d和Int分别在左侧凸组与对照组、右侧凸组与对照组的组间对比采用独立样本t检验;Cobb角及冠状位偏移距离与α、γ、d和Int的相关性检验采用Pearson相关分析。结果:左侧凸组Cobb角为23.7°±12.7°(10.4°～42.5°),冠状位偏移距离为45.2±10.7mm(25.5～77.7mm);右侧凸组Cobb角为20.8°±10.4°(11.0°～48.4°),冠状位偏移距离为47.8±15.1mm(25.4～77.5mm),两侧凸组的顶椎分布(P=0.280)、Cobb角(P=0.311)和冠状位偏移距离(P=0.394)均无统计学差异。对照组α平均为-2.96°±6.40°,从T12～L4逐渐减小,而左侧凸组α(-2.57°±6.14°)无该规律,两组α比较无统计学差异(P=0.554);左侧凸组γ平均为5.57°±5.32°;左侧凸组d(4.62±0.57cm)自T12～L4逐渐增大,且与对照组(4.44±0.43cm)比较有统计学差异(P0.001);左侧凸组Int与对照组比较无统计学差异(P=0.832),即相对于正常人群,DLS左侧凸患者腹主动脉相对于椎体角度无改变,但距离稍远离左侧椎体。右侧凸组α(-3.41°±9.44°)自T12～L4逐渐减小,与对照组比较无统计学差异(P=0.762);γ为-9.02°±6.71°;d为4.54±1.84cm,与对照组比较无统计学差异(P=0.530);Int与对照组比较无统计学差异(P=0.807),即相对于对照组,DLS右侧凸患者腹主动脉与椎体的角度和距离无明显变化。Pearson相关分析显示,左侧凸组和右侧凸组Cobb角和冠状位偏倚距离与γ均存在相关性(均为P0.001),而与α、d和Int无明确相关性。结论:DLS右侧凸患者腹主动脉与椎体相对位置维持正常的解剖关系,左侧凸患者腹主动脉稍远离左侧椎弓根。DLS患者腹主动脉与腰椎相对解剖关系较正常人变化不大,但腰椎手术尤其是侧凸矫形过程中仍需要警惕腹主动脉损伤。     

退变性腰椎侧凸合并椎管狭窄的阶梯性治疗策略

目的退变性腰椎侧凸合并椎管狭窄多为中老年患者,治疗方法选择复杂。探讨退变性腰椎侧凸合并椎管狭窄的阶梯性治疗策略及疗效。方法 2005年1月-2009年12月,收治退变性腰椎侧凸合并椎管狭窄患者117例,根据患者意愿、内科合并症、腰腿痛症状、腰椎侧凸后凸旋转三维畸形、腰椎稳定性的情况(侧方滑移、退变性滑脱),以及脊柱整体平衡状态,阶梯性地选择保守治疗(43例)、后路单纯减压术(18例)、后路短节段融合术(1～2个节段,41例)、后路长节段融合畸形矫正(≥3个节段,15例)方法治疗。比较患者治疗前后腰痛及腿痛的疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、腰椎前凸角、侧凸Cobb角的变化。结果术后获1年以上随访72例;无死亡及内固定失败。保守治疗19例平均随访19.3个月(1～5年),无症状加重,末次随访时腰痛及腿痛VAS评分、ODI较治疗前明显降低(P<0.05),腰椎前凸角减小、侧凸Cobb角增大,但与治疗前比较差异无统计学意义(P>0.05)。后路单纯减压术12例平均随访36个月(1～5年),末次随访时腿痛VAS评分、ODI较治疗前均明显降低(P<0.05),腰痛VAS评分较治疗前减小,但差异无统计学意义(P>0.05);腰椎前凸角减小、侧凸Cobb角增大,但进展缓慢,与治疗前比较差异无统计学意义(P>0.05)。后路短节段融合31例平均随访21.3个月(1～3年),术后发生血肿、切口愈合不良、脑脊液漏、浅表感染各1例,经对症处理后治愈;末次随访时腰痛及腿痛VAS评分、ODI较治疗前均明显降低(P<0.05),腰椎前凸角及侧凸Cobb角均明显改善(P<0.05)。后路长节段融合10例平均随访17.1个月(1～3年),术后症状加重1例,经理疗及药物治疗3个月后缓解;术后深部感染1例,经清创切口持续冲洗引流后治愈;末次随访时腰痛及腿痛VAS评分、ODI、腰椎前凸角及侧凸Cobb角均较治疗前明显改善(P<0.05)。结论退变性腰椎侧凸合并椎管狭窄的治疗应个体化、阶梯性地选择治疗方案。手术治疗以减压为主、矫形为辅,应准确判断症状责任节段、侧凸责任节段、后凸责任节段,防止手术扩大化,积极控制出血,提高手术安全性。     

退变性腰椎侧凸矫形术后腰椎前凸角变化对临床疗效的影响

目的 :评估退变性腰椎侧凸(degenerative lumbar scoliosis,DLS)患者行长节段固定矫形术后腰椎前凸角与脊柱-骨盆矢状位参数匹配与否对临床疗效的影响。方法:对我院2015年6月~2016年6月行腰椎长节段矫形固定术(至少4个椎体)的DLS患者,参照理想腰椎前凸角(lumbar lordosis,LL)=0.6PI+0.4TK+10°,根据出院时LL分为两组,A组(匹配组,术后LL在理想LL±10°范围内)和B组(非匹配组,术后LL在理想LL±10°范围外),利用院内影像归档与通信系统(picture archiving and communication system,PACS)在全脊柱正侧位X线片上测量侧凸Cobb角、冠状位平衡(coronal vertical axis,CVA)、骨盆入射角(pelvic incidence,PI)、骨盆倾斜角(pelvic tilt,PT)、骶骨倾斜角(sacral slope,SS)、腰椎前凸角(lumber lordosis,LL)、胸椎后凸角(thoracic kyphosis,TK)、矢状位平衡(sagittal vertical axis,SVA)等,采用视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)评价患者术后生活质量,随访至少12个月。使用独立样本t检验比较两组影像参数和生活质量评分。结果:共纳入患者100例(A组53例,B组47例),其中男性43例,女性57例,平均侧凸Cobb角为17.5°±7.8°。两组患者随访时间、手术节段、术前侧凸Cobb角、术前的CVA、LL、SS、SVA均无明显差异性(P0.05);术后两组患者的LL、SS、SVA、PT具有明显差异性(P0.01),A组患者LL(42.2°±10.2°)较术前(31.6°±15.5°)明显改善,TK、SS增大,PT减小,术后SVA(17.9±28.5mm)较术前(46.0±37.9mm)明显改善。B组患者术后相关矢状位参数较术前均无明显变化。两组患者术后VAS评分、ODI评分较术前均有明显改善,经3~6个月的短期随访两组患者术后症状评分无明显差异性;经12个月以上随访,A组患者较B组患者腰腿痛VAS评分明显改善(P0.05),ODI评分无明显差异(P=0.08)。结论:退变性腰椎侧凸患者根据公式0.6PI+0.4TK+10°重建腰椎前凸,可以获得满意的脊柱-骨盆矢状位平衡,有助于提高DLS患者术后生活质量。     

椎管狭窄伴退行性腰椎侧凸的减压及非融合动态稳定术疗效分析

目的：分析减压与非融合稳定系统运用在椎管狭窄伴退行性腰椎侧凸（DLS）患者的临床疗效。方法：对2014年1月至2017年6月接受减压及Dynesys系统非融合稳定手术治疗的48例椎管狭窄伴DLS患者进行回顾性分析,其中男17例,女31例,年龄54～78（64.3±5.7）岁。通过影像学观察术后腰椎前凸、侧凸角度及活动范围（ROM）,采用视觉模拟评分（VAS）评价背部和腿部的疼痛情况,采用韩国版Oswestry残疾指数（ODI）评定临床功能。结果：48例患者施行了68个节段的减压与非融合稳定手术,均获得2年以上的随访,时间24～74（31.4±10.4）个月。手术时间100～220（183.1±31.8）min,术中出血量100～500（222.0±115.3）ml,住院天数4～9（6.5±1.9）d。术后腰椎侧凸角明显改善（P<0.05）,腰椎前凸和活动范围未受影响。末次随访背部和腿部疼痛的VAS评分分别为3.5±2.4和4.2±4.3,ODI为（36.5±5.8）%,较术前明显改善。结论：对于椎管狭窄伴轻至中度脊柱侧凸（<30°）的老年患者,先后施行减压术与非融合稳定技术是一种安全有效的手术方法。     

退行性腰椎侧凸与骨质疏松症的相关性分析

目的:研究成年人腰椎退变性侧凸与骨质疏松的相互关系。方法:自2012年3月至2016年6月,采用回顾性分析方法对53例腰椎退变性侧凸患者进行腰椎退变性侧凸与骨质疏松症相关性研究,男11例,女42例,年龄63～76岁,平均69岁,匹配同期就诊的非腰椎侧凸患者53例,其中腰椎间盘突出症33例,腰椎管狭窄症13例,腰椎滑脱症7例,男16例,女37例,年龄59～74岁,平均68.5岁。53例患者均拍摄腰椎正侧位X线片及腰椎MRI确诊,测量并记录腰椎侧凸Cobb角。运用双能X射线吸收法对所有患者进行骨密度检查,记录腰椎(L_2-L_4)、股骨颈、股骨粗隆、Ward三角部位T值。采用Linear regression研究腰椎侧凸角度与骨质疏松的相关性。结果:腰椎侧凸组与非腰椎侧凸组两者骨密度T值差异有统计学意义,腰椎退变性侧凸患者骨密度T值(-2.56±0.65)明显高于非腰椎侧凸组(-1.39±0.77)(P0.05),腰椎侧凸患者腰椎(L_2-L_4)、股骨颈、股骨粗隆、Ward三角部位的T值与侧凸Cobb角无明显相关性。结论:骨质疏松是发生腰椎退变性侧凸的危险因素,但侧凸程度与骨质疏松程度无明显相关性。     

Calcification in human intervertebral disc degeneration and scoliosis

Calcification is a pathological process that may lead to impairment of nutrient supply and disc metabolism in degenerative and scoliotic intervertebral discs (IVDs). The purpose of this study was to assess the calcification potential of IVDs in degenerative disc disease (DDD) and adolescent idiopathic scoliosis (AIS). For this purpose, 34 IVDs from 16 adult patients with DDD and 25 IVDs from 9 adolescent patients with AIS were obtained at surgery. The concave and convex parts of the scoliotic discs were analyzed separately. Von Kossa staining was performed to visualize calcium deposits, while type X collagen (COL X) expression associated with endochondral ossification was measured by immunohistochemistry. Alkaline phosphatase activity and calcium and inorganic phosphate concentrations were used as indicators of calcification potential. Results showed the presence of calcium deposits and COL X in degenerative and scoliotic IVDs, but not in control discs, and the level of the indicators of calcification potential was consistently higher in degenerative and scoliotic discs than in control discs. The results suggest that disc degeneration in adults is associated with ongoing mineral deposition and that mineralization in AIS discs might reflect a premature degenerative process. © 2011 Orthopaedic Research Society Published by Wiley Periodicals, Inc. J Orthop Res 29:1888–1895, 2011     

Short fusion versus long fusion for degenerative lumbar scoliosis

The extent of fusion for degenerative lumbar scoliosis has not yet been determined. The purpose of this study was to compare the results of short fusion versus long fusion for degenerative lumbar scoliosis. Fifty patients (mean age 65.5 ± 5.1 years) undergoing decompression and fusion with pedicle screw instrumentation were evaluated. Short fusion was defined as fusion within the deformity, not exceeding the end vertebra. Long fusion was defined as fusion extended above the upper end vertebra. The lower end vertebra was included in the fusion in all the patients. The short fusion group included 28 patients and the long fusion group included 22 patients. Patients’ age and number of medical co-morbidities were similar in both the groups. The number of levels fused was 3.1 ± 0.9 segments in the short fusion group and 6.5 ± 1.5 in the long fusion group. Before surgery, the average Cobb angle was 16.3° (range 11–28°) in the short fusion group and 21.7° (range 12–33°) in the long fusion group. The correction of the Cobb angle averaged 39% in the short fusion group and 72% in the long fusion group with a statistical difference (P = 0.001). Coronal imbalance improved significantly in the long fusion group more than in the short fusion group (P = 0.03). The correction of lateral listhesis was better in the long fusion group (P = 0.02). However, there was no difference in the correction of lumbar lordosis and sagittal imbalance between the two groups. Ten of the 50 patients had additional posterolateral lumbar interbody fusion at L4-5 or L5-S1. The interbody fusion had a positive influence in improving lumbar lordosis, but was ineffective at restoring sagittal imbalance. Early perioperative complications were likely to develop in the long fusion group. Late complications included adjacent segment disease, loosening of screws, and pseudarthrosis. Adjacent segment disease developed in ten patients in the short fusion group, and in five patients in the long fusion group. In the short fusion group, adjacent segment disease occurred proximally in all of the ten patients. Loosening of distal screws developed in three patients, and pseudarthrosis at L5-S1 in one patient in the long fusion group. Reoperation was performed in four patients in the long fusion group and three patients in the short fusion group. In conclusion, short fusion is sufficient for patients with small Cobb angle and good spinal balance. For patients with severe Cobb angle and rotatory subluxation, long fusion should be carried out to minimize adjacent segment disease. For patients who have severe sagittal imbalance, spinal osteotomy is an alternative technique to be considered. As long fusion is likely to increase early perioperative complications, great care should be taken for high-risk patients to avoid complications.     

退变性腰椎侧凸脊柱-骨盆矢状位影像学特点

目的 :观察退变性腰椎侧凸(DLS)患者脊柱-骨盆矢状位影像学特点,探讨脊柱-骨盆矢状位参数变化对DLS发生的影响。方法:回顾性分析103例DLS患者术前资料,男36例,女67例,年龄62.6±7.4(43~78)岁,并选取139例正常青年人群作为正常青年对照组,145例单纯颈椎病患者作为成年对照组,在脊柱全长正侧位X线片上测量各组冠状位、矢状位参数,包括L3倾斜角、侧凸Cobb角、冠状位平衡(CVA)、腰椎前凸角(LL)、矢状位平衡(SVA)、胸椎后凸角(TK)、骨盆入射角(PI)、骨盆倾斜角(PT)、骶骨倾斜角(SS)等,采用独立样本t检验比较DLS组与两对照组的各矢状位参数,并用Pearson相关分析DLS组各参数间相关性。结果:DLS组PI为50.4°±10.2°,显著高于正常青年对照组(45.1°±9.6°,P0.01)和成年对照组(46.9°±9.1°,P0.01)。与青年及成年对照组相比,DLS组LL、SS较小(P0.01),PT、SVA较大(P0.01);TK小于成年对照组(P0.01)。DLS组中合并退变性腰椎滑脱者37例(占35.9%),PI为53.1°±8.8°;无退变性腰椎滑脱者66例,PI为48.9°±10.6°,二者相比有统计学差异且均显著高于正常青年对照组(P0.05)。DLS组侧凸Cobb角与PT显著相关(P0.05),余冠状位参数与矢状位参数间未发现相关性;LL、PI、SS、PT两两之间显著相关(P0.01),LL、PT与TK显著相关(P0.01),SS与TK显著相关(P0.05),LL与SVA显著相关(P0.01)。结论 :DLS患者PI高于正常青年及颈椎病患者,高PI可能参与了DLS的发病机制;DLS患者退变、侧凸的腰椎仍存在调节矢状位平衡的能力。     

Clinical outcomes of microscopic decompression for degenerative lumbar foraminal stenosis: a comparison between patients with and without degenerative lumbar scoliosis

We performed microscopic lumbar foraminotomy in all the patients diagnosed with degenerative lumbar foraminal stenosis (DLFS) and retrospectively reviewed the clinical outcomes and the factors influencing them. The preoperative Japanese Orthopaedic Association (JOA) score of 13.8 significantly improved to 21.9 postoperatively. Although leg pain reduced in 44 patients (95.7%) immediately after surgery, it recurred in 9 patients (19.6%). The recurrence frequency was significantly higher and the JOA score improvement ratios significantly lower in patients with degenerative lumbar scoliosis (DLS) than in those without DLS. Even among patients with DLS, those with <3° Cobb angle difference between the supine and standing positions showed satisfactory results, with no recurrence. In conclusion, microscopic lumbar foraminotomy for DLFS produced satisfactory clinical outcomes even in patients with DLS. However, the outcomes were poor in patients with unstable DLS.