| Objective: By comparing the degeneration of upper adjacent segments after double segmental posterior lumbar fusion(PLIF)and topping-off assisted by waveflex semi-rigid internal fixation system in the treatment of lumbar degenerative diseases,to explore whether the waveflex semirigid internal fixation system under the guidance of "dynamic and static combination" theory can effectively delay the degeneration of upper adjacent segments,in order to provide a basis for the selection of clinical operation scheme.Methods: A total of 51 patients with lumbar degenerative diseases that hospitalized and surgically treated in the Department of spine orthopedics of the Affiliated Hospital of Shandong University of traditional Chinese medicine from January 2018 to October 2020 were collected,Among them,24 cases were treated with Waveflex semi-rigid internal fixation system combined with posterior fusion internal fixation(topping-off group)and27 cases were treated with double segmental posterior rigid fusion fixation(PLIF group).Japanese Orthopaedic Association Scores(JOA),visual analog scale(VAS)and Oswestry disability index(ODI)were used to evaluate clinical efficacy.In terms of objective imaging indexes,the intervertebral space height index(IHI)and intervertebral range of motion(ROM)of the upper adjacent segments were collected before operation and at the last follow-up.Weishaupt grade was used to evaluate the degeneration of vertebral facet joints,and Pfirrmann grade was used to evaluate the changes of intervertebral discs.Results: There was no statistically significant difference between the two groups in baseline data such as age,gender,follow-up time,BMI index,operation time,bleeding volume,length of hospital stay and preoperative evaluation indexes(P>0.05).During follow-up,there was statistically significant difference in VAS score between the two groups at the last follow-up(P<0.05),but there was no statistically significant difference at 3 and 6 months after operation(P>0.05),while there was no significant difference between Oswestry disability index and JOA score at each time point of follow-up(P>0.05).In the two groups,the VAS score,Oswestry disability index,and JOA score differences were statistically significant compared with preoperative follow-up(P<0.05).In terms of imaging indicators,the difference between the intervertebral space height index and intervertebral range of motion between the two groups was statistically significant compared with the preoperative difference at the last followup(P<0.05),the difference between the two groups was not statistically significant at the last follow-up(P>0.05),and the difference between the two groups was statistically significant at the last follow-up(P<0.05).In terms of Weishaupt grading,16 cases(66.7%)did not change in the Topping-off group,8 cases(33.3%)in the Topping-off group,16 cases(59.3%)did not change in the PLIF group,11 cases(40.7%)degenerated,there was no statistically significant difference between groups(P>0.05),and in the Pfirrmann rating,18 cases(75%)did not change in the Toppingoff group.There were 6 cases(25%)of the degeneration,11 cases(40.7%)of the PLIF group did not change,and 16 cases(59.3%)of the degeneration occurred,and the difference between the groups was statistically significant(P<0.05).Conclusion: 1.Topping-off operation based on Waveflex semi-rigid system is superior to traditional rigid fixation group in medium-term pain control.2.Topping-off operation based on Waveflex semi-rigid system can delay the increase of upper adjacent segment activity.3.Topping-off operation based on Waveflex semi-rigid system can delay the degeneration of upper and adjacent intervertebral discs.4.Under the guidance of the theory of "dynamic and static combination",the Waveflex semi-rigid system pays attention to the dynamic and static balance from the whole or the local,which can effectively alleviate the symptoms of patients and delay the degeneration of the upper adjacent segment,which has the value of promotion. |
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