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| CHEN Qixin,WEN Junxia,LI Fangcai.The effect of different distal instrumented vertebra on posterior long segment fusion for lumbar spine degenerative disease[J].Chinese Journal of Spine and Spinal Cord,2014,(8):710-716. |
| The effect of different distal instrumented vertebra on posterior long segment fusion for lumbar spine degenerative disease |
| Received:July 02, 2014 Revised:July 30, 2014 |
| English Keywords:Degenerative lumbar scoliosis Lower instrumented vertebra Posterior long fusion |
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| English Abstract: |
| 【Abstract】 Objectives: To evaluate the influence of different distal instrumented vertebra(DIV) on the outcomes of posterior spinal fusion for degenerative lumbar scoliosis. Methods: 63 patients with degenerative lumbar scoliosis who underwent posterior long segment fusion surgery from January 2005 to January 2012 in our hospital were selected for the present retrospective study. There were 16 males and 47 females, and the average age was 61.4 years(range 50 to 72 years). All patients were divided into two groups based on the different distal instrumented vertebra: L5(group A, n=44) and S1(group B, n=19). The operation time, operative bleeding and fusion segments were compared between two groups. Radiographic measurement included coronal Cobb angle, apical vertebra translation(AVT), coronal vertical axis(CVA), lumbar lordosis(LL), thoracolumbar kyphosis(TK), sagittal vertical axis(SVA), pelvic incidence(PI), pelvic title(PT), sacral slop(SS) and the amount of the fusion levels on the standing anterior-posterior radiographs before and after surgery. The complications were analyzed in the two groups. Results: Although the operation time and operative bleeding showed no significant difference between group A and B(P>0.05), the mean fusion segment in group A was shorter than group B(P<0.05). The postoperative spine parameters improved significantly in group A compared with the preoperative ones(P<0.05). The Cobb angle, apical vertebra translation(AVT), lumbar lordosis(LL), thoracolumbar kyphosis(TK) showed significant differences in group B between preoperation and postoperation(P<0.05). However, no difference in the coronal and sagittal balance parameters could be found(P>0.05). On the other hand, there was no significant difference of PI between preoperation and postoperation in group A or B(P>0.05). In group A, the postoperative PT significantly declined compared with the preoperative PT, and SS showed the reverse change(P<0.05). Meanwhile, similar change was showed in these parameters of group B, but no significant difference was noted(P>0.05). 7 complications were noted in group A(15.91%) and 8 in group B(42.11%)(P<0.0001). Conclusions: In the posterior long segment fusion for DLS, selecting L5 or S1 as distal instrumented vertebra can achieve similar outcome, while selecting L5 as DIV can effectively preserve the motion of L5/S1. Meanwhile, selecting sacral vertebra as DIV has a higher incidence of complications. |
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