| BackgroundPosterior lumbar interbody fusion has become one of the commonly used effective techniques for the treatment of various lumbar degenerative diseases.Segmental stiffness caused by internal fixation increases the stress of adjacent segments,and the risk of postoperative adjacent segmental degeneration is greatly increased.At present,some scholars suggest that the posterior ligament complex may affect the motion and bearing characteristics of adjacent segments,resulting in ASD after adjacent segments.Our department has improved the traditional posterior lumbar interbody fusion in recent years.Compared with traditional PLIF,the modified PLIF retains part of the spinous process and lamina of the diseased segment,providing an attachment point for the ligamentum flavum,supraspinous ligament and interspinous ligament,thus preserving the integrity of the PLC of adjacent segments.ObjectiveThis study,through retrospective analysis,compared the effect of preserving PLC on the incidence of ASD in adjacent segments after lumbar fusion and the difference in clinical efficacy.To investigate the effect of the PLC on the incidence of the ASD after posterior lumbar spinal fusion.MethodPatients with 4/5 lumbar intervertebral disc herniation treated by PLIF in the First Affiliated Hospital of Xinxiang Medical University from January 2010 to January 2016 were selected as subjects.According to inclusion and exclusion criteria,50 patients which were retained the PLC in the improved PLIF surgery were group A,male female ratio of 23:27,age of 39 to 60 years old,average of(50.44±6.55)years old,medical history of 9 to 24 months average of(16.00±4.78)months,follow-up time of 15 to 38 months,average(27.42±1.40)months.Another 50 patients which were resected the PLC in the traditional operation were group B,male female ratio of 26:24,age of 37 to 58 years old,average of(50.22±5.98)years old,medical history of 10 to 25 months,average of(27.48±1.68)months.Imaging evaluation of two groups of adjacent segment degeneration was performed by X-ray examination.Pain visual analogue scale and Oswestry functional index were used to evaluate the clinical efficacy of the two procedures.Results1.At the last follow-up,the VAS and ODI scores were remarkably lower than the preoperative scores(P<0.05),but no significant difference in scores was noted between the two groups(P>0.05).2.At the last follow-up,there were 8 cases(16.0%)of ASD in the group A,including 7 cases(14.0%)of radiographic ASD and 1 case(2.0%)of symptomatic ASD.There were 28 cases(56.0%)of ASD in the group B,including 20 cases(40.0%)of radiographic ASD and 8 cases(16.0%)of symptomatic ASD.The incidence of ASD,imaging degeneration rate and symptomatic degeneration rate in the group A were significantly lower than those in the group B(P<0.05).3.Among the 8 patients with ASD in the group A,5 cases(62.5%)had degeneration of the headend,3 cases(37.5%)had degeneration of the tail,there was no statistically significant difference in the incidence of headend and tail degeneration(P>0.05).Among the 28 patients with ASD in the group B,21 cases(75.0%)had degeneration of the headend,7 cases(25.0%)had degeneration of the tail,the proportion of headend degeneration was significantly higher than that of tail degeneration(P<0.05).4.There were no significant relationship between the radiograph of ASD and the clinical effect(P>0.05),whereas the symptom ASD was significantly connected with the clinical results(P<0.05).ConclusionThe clinical effect of improved PLIF is similar to that of traditional PLIF in the treatment of lumbar disc herniation,but the improved PLIF with preservation of PLC can significantly reduce the incidence of ASD(especially headend degeneration)after operation. |
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