目的:本研究的目的是探讨腰椎多裂(LM)肌肉的脂肪浸润是否影响L4-5经椎间孔腰椎椎间融合术(TLIF)治疗退行性腰椎滑脱后邻近节段变性(ASD)的翻修手术率。
方法:对2006-2016年178例接受单级别L4-5TLIF治疗的腰椎滑脱患者进行回顾性分析。纳入标准是至少2年随访,术前MR图像和X光片,和单水平L4-5TLIF治疗退行性腰椎滑脱。23例患者在随访期间接受了ASD翻修手术。另外23例非ASD患者与ASD患者相匹配。人口统计数据,Rousouly曲率类型,收集脊髓管参数数据。使用Goutallier分类系统在术前MRI上评估了LM肌肉(L3,L4和L5)的脂肪浸润。
结果:共46例患者接受评估。年龄没有差异,性别,BMI,对于有ASD和无ASD的患者(p>0.05)。与没有ASD的患者相比,患有ASD的患者LM的脂肪浸润明显更大(p=0.029)。与无ASD的患者相比,有ASD的患者在L3的脂肪浸润最为显着(p=0.017)。在L4和L5时,ASD患者的脂肪浸润比非ASD患者有增加的趋势。但差异无统计学意义(L4为p=0.354,L5为p=0.077)。
结论:L4-5TLIF治疗腰椎滑脱后,LM的脂肪浸润可能与ASD有关。L3处的脂肪浸润也可与L4-5TLIF后L3-4处的ASD相关。
The aim of this study was to investigate whether fat infiltration of the lumbar multifidus (LM) muscle affects revision surgery rates for adjacent-segment degeneration (ASD) after L4-5 transforaminal lumbar interbody fusion (TLIF) for degenerative spondylolisthesis.
A total of 178 patients undergoing single-level L4-5 TLIF for spondylolisthesis (2006 to 2016) were retrospectively analyzed. Inclusion criteria were a minimum 2-year follow-up, preoperative MR images and radiographs, and single-level L4-5 TLIF for degenerative spondylolisthesis. Twenty-three patients underwent revision surgery for ASD during the follow-up. Another 23 patients without ASD were matched with the patients with ASD. Demographic data, Roussouly curvature type, and spinopelvic parameter data were collected. The fat infiltration of the LM muscle (L3, L4, and L5) was evaluated on preoperative MRI using the Goutallier classification system.
A total of 46 patients were evaluated. There were no differences in age, sex, BMI, or spinopelvic parameters with regard to patients with and those without ASD (p > 0.05). Fat infiltration of the LM was significantly greater in the patients with ASD than in those without ASD (p = 0.029). Fat infiltration was most significant at L3 in patients with ASD than in patients without ASD (p = 0.017). At L4 and L5, there was an increasing trend of fat infiltration in the patients with ASD than in those without ASD, but the difference was not statistically significant (p = 0.354 for L4 and p = 0.077 for L5).
Fat infiltration of the LM may be associated with ASD after L4-5 TLIF for spondylolisthesis. Fat infiltration at L3 may also be associated with ASD at L3-4 after L4-5 TLIF.