| The first part. Study on the lumbar 4-5 intervertebral disc height and intervertebral disc height index of population with normal lumbar 4-5 intervertebral discObjectives To measure the lumbar 4-5 intervertebral disc height and intervertebral disc height index of population with normal lumbar 4-5 intervertebral disc.Methods 478 patients examined by lumbar vertebra MRI and the results suggested the lumbar segment 4-5 was normal in our hospital from January 2013 to June 2014 were collected. According to the inclusion and exclusion criteria, a total of 269 patients were incorporated into the group. Among them, 137 were male and 132 were female. These patients were divided into three groups: young group(20-40 years old), middle-aged group(40-60 years old) and the elderly group(over 60 years old) to measure the L4-5 intervertebral disc height and intervertebral disc height index and statistical analysis. Change rules of normal L4-5 intervertebral disc height and intervertebral disc height index in different age groups were analyzed.Results 269 patients with normal L4-5 intervertebral disc height and intervertebral disc height index were measured. Among them, 100 patients were in the young group(20-40 years old), 47 were male and 53 were female; 107 patients were in the middle-aged group(40-60 years old), 57 were male and 50 were female; 62 patients were in the elderly group(>60 years old), 33 were male and 29 were female. L4-5 intervertebral disc height of the young group(20-40 years old) was 14.9±2(mm), the middle-aged group(40-60 years old) was 15.4±2(mm), and the elderly group(more than 60 years old) was 12±1.4(mm). L4-5 intervertebral disc height index of the young group(20-40 years old) was 0.33±0.04, the middle-aged group(40-60 years old) was 0.34±0.03, and the elderly group(over 60 years) was 0.28±0.02. The intervertebral disc height and intervertebral disc height index was significantly reduced in the elderly group compared to the young group and the middle-aged group with statistical difference(P<0.05).Conclusion L4-5 intervertebral disc height and intervertebral disc he ight index of population with normal lumbar 4-5 intervertebral disc were different in different ages. intervertebral disc height and intervertebral disc height index of the population below 60-year-old increase with age, while they decrease significantly after 60 years old.The second part. The influence of the intervertebral disc height and intervertebral disc height index in the single segmental lumbar fusion on the spino pelvic parameters and clinical effectsObjectives To explore the influence of intervertebral disc height and intervertebral disc height index in the lumbar 4-5 single segment fusion on spino pelvic parameters and clinical curative effect.Methods 354 patients conducted with SL4-5 segment standard TLIF operation in our hospital from March 2008 to March 2014 were collected. According to the inclusion and exclusion criteria, a total of 58 patients were incorporated into the group. These patients were divided into young group(20-40 years) and middle-aged group(40-60 years). Patients were assessed by visual analogue scale(VAS), Oswestry disability index(ODI), lumbar JOA score, measurement of lumbar lordosis(LL), lumbar 4-5(IDH) lumbar intervertebral disc height, lumbar 4-5 intervertebral disc height index(IDHI), intervertebral angle of lumbar 4-5(IVA4-5), pelvic incidence(PI), pelvic tilt(PT), sacral slope(SS) and other spino pelvic parameters preoperatively, postoperatively and at final follow-up. The changes in preoperative, postoperative and follow-up of 4-5 lumbar intervertebral disc height and 4-5 lumbar intervertebral disc height index were statistically analyzed and the effect and correlation to the spino pelvic parameters and clinical efficacy were also analyzed.Results The mean follow-up period was 49.89 months(36-81 months), the distribution of the patients were as follows: 16 patients in the young group(20-40 years old) and 42 patients in the middle age group(40-60 years old). L4-5 intervertebral disc height of the young group in the preoperative, postoperative and follow-up was respectively: 11.8±1.9(mm), 15±1.9(mm) and 13.3±1.8(mm). L4-5 intervertebral disc height index in preoperative, postoperative and follow-up was respectively: 0.30±0.04, 0.33±0.04 and 0.29±0.04. L4-5 intervertebral disc height of the middle-aged group in preoperative, postoperative and follow-up was respectively: 11.8±1.9(mm), 13.9±1.6(mm) and 12.5±1.8(mm). L4-5 intervertebral disc height index in preoperative, postoperative and follow-up was respectively: 0.27±0.04, 0.33±0.03 and 0.29±0.03. The intervertebral disc height and intervertebral disc height index was significantly increased in postoperative compared to preoperative with statistical difference(P<0.05). But in the follow-up compared with postoperative, it has decreases in different degrees with statistical significance(P<0.01). Study on the correlation between L4-5 intervertebral disc height, intervertebral disc height index and spino pelvic parameters indicated that: L4-5 intervertebral disc height and intervertebral disc height index was significantly correlated with IVA4-5(P<0.05), and had no significant correlation with other spino pelvic parameters(P > 0.05). In the clinical curative effect evaluation, VAS, ODI and JOA imp rovement rate of each age group after operation and the last follow-up was significantly improved compared with the preoperative one. Among them, the VAS and ODI score in the last follow-up was negatively corelated with postoperative L4-5 intervertebral disc height(P<0.05), and JOA improvement rate was positively correlated with postoperative L4-5 intervertebral disc height(P<0.05). While the final follow-up VAS and ODI score was negatively correlated with postoperative L4-5 intervertebral disc height index(P<0.05), and the final follow-up JOA improvement rate was positively correlated with postoperative intervertebral disc height index(P<0.05).Conclusion L4-5 intervertebral disc height and intervertebral disc height index was significantly correlated with IVA4-5.The increase of intervertebral disc height and intervertebral disc height index can improve the clinical efficacy of the single segment fusion.The third part. The influence of the intervertebral disc height and intervertebral disc height index in the single segmental lumbar fusion on the radiographicadjacent segment degeneration(r ASD)Objectives To analyze the risk factors of radiograph radiographicadjacent segment degeneration(r ASD) after single segmental L4-5 fusion,and explore the influence of intervertebral disc height and intervertebral disc height index on r ASD.Methods 354 patients conducted with SL4-5 segment standard TLIF operation in our hospital from March 2008 to March 2014 were collected. According to the inclu sion and exclusion criteria, a total of 58 patients were incorporated into the group. These patients were also divided into young group(20-40 years) and middle-aged group(40-60 years). The clinical data of the second part was as the research object, the degeneration of lumbar MRI adjacent segment was evaluated by Modified Pfirrmann Scale before the operation, the degeneration of X-ray adjacent segment was evaluated by UCLA Grading Scale during follow-up, its stability in dynamic X radiographs was evaluated and the occurrence of r ASD in each age groups was studied respectively. According to whether the intervertebral disc height index would be returned to the normal reference range during the operation, the young group was divided into two groups: A1 group(intraoperative L4-5 intervertebral disc height index returned to the normal reference value) and A2 group(intraoperative L4-5 index of intervertebral disc height was not returned to the normal reference value), the middle aged group was divided into B1 group(with the L4-5 intervertebral disc height index returned to the normal reference value) and B2 group(intraoperative L4-5 index of intervertebral disc height was not returned to the normal reference value). The incidence of each subgroup of r ASD was analyzed. On this basis, the risk factors of r ASD after single segmental L4-5 fusion were explored and the effect of intervertebral disc height index on r ASD was analyzed.Results In the 58 taken SL4-5 segment standard TLIF patients, there were 11 patients occurred with r ASD and the incidence rate was 26.2%. Among them, there was no patients occurred with r ASD in the young group, but 11 patients were found in the middle-aged group and the incidence rate was 30.6%, which indicated that the age was significantly associated with the occurrence of r ASD. There were 6 patients in the A1 group and 10 patients in the A2 group, both had no r ASD occurrence. There were 16 patients in the B1 group and 1 was occurred with r ASD, the incidence rate was 6%. There were 26 patients in the B2 group and 10 were occurred with r ASD, the incidence rate was 35.5%. The incidence of ASD between B1 and B2 group had statistical significance(P<0.05). When analysis of the risk factors for r ASD was conducted in the middle-aged group, it was found that: age, duration of follow-up, L4-5 intervertebral disc height index and PI were risk factors. Logistics regression analysis indicated that: p<0.00001 in the wald test of L4-5 intervertebral disc height index and OR odds ratio was 172.16. L4-5 intervertebral disc height index was the main risk factors.Conclusion Age and intervertebral disc height index are the significant risk factors of postoperative r ASD. the short term follow-up indicated that no r ASD occurred to the patients of or below 40 years old no matter whether the intervertebral disc height index of the patients was increased to the normal range during the operation or not. But for patients over the age of 40, the recovery of intervertebral disc height index to normal reference range during the operation reduced the incidence of r ASD, which may result from the change of the adjacent segment degeneration process. |
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