Focus on iatrogenic factors, strengthen follow-up study, and deepen the understanding of adjacent segment degeneration after lumbar fusion
10.3760/cma.j.cn121113-20220821-00460
- VernacularTitle:重视医源性因素，加强随访研究，深化对腰椎融合术后邻近节段退变的认识
- Author:
Jianyuan JIANG
1
Author Information
1. 复旦大学附属华山医院骨科，上海 200040
- From:
Chinese Journal of Orthopaedics
2022;42(19):1249-1253
- CountryChina
- Language:Chinese
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Abstract:
Adjacent segment disease (ASDis) is a kind of mid- or long-term complication after lumbar spinal fusion. Although natural degenerative factors and patients' characteristics play a major role in the development of ASDis, iatrogenic related factors, especially surgical related factors, are also important factors affecting ASDis. The research shows that injury of posterior ligament complex, insufficient recovery of the disc height and lumbar alignment, and violation of the implant on adjacent segments will accelerate ASDis. Therefore, attention should be paid to the protection of the posterior lumbar structure, suitable reconstruction of the disc height and alignment of the lumbar spine, and avoiding the violation of the implant on adjacent segments. In addition, the quality of clinical research on ASDis has gradually improved in recent years, but there are still many problems, including small sample size, short follow-up time, low evidence level, and poor clinical values. To solve these problems, randomized controlled trial (RCT) should be conducted to evaluate the impact of specific factors on ASDis in order to obtain high level evidence. On the other hand, real world studies (RWS) should also be conducted, focusing on the actual problems encountered in clinical practice, through the real medical environment and medical process, to obtain the results with guidance and value for clinical problems.
