中華民國骨科醫學會109年度第78次聯合學術研討會投稿
中華民國骨科醫學會109年度第78次聯合學術研討會投稿
投 稿 類 別 : █ 口頭演講 □ 壁報 □ 兩者皆可
論 文 分 類 : □Adult Recon □Pediatrics □Hand □Sports □Trauma □Research
█Spine □Tumor □Foot-Ankle □Infection □Knee Arthroscopy
□Shoulder Elbow □Physician clinic □Others: ____________
參加優秀論文比賽︰□ 參加 █ 不參加 (請注意:1.僅接受本會會員及骨科專科住院醫師參加,非以上
身分者請勾選「不參加」。2. 108 年度起取消壁報優秀論文比賽。)
(以上資料務必詳填,缺一不可,未按規定作業者﹐恕不受理)
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題目(Title) Comparison of The Morphology Change of Adjacent Disc After Anterior Lumbar Interbody
Fusion and Oblique Lateral Interbody Fusion
ALIF 與 OLIF 術後鄰近節椎間盤型態改變之比較
作者(Author) 許芳偉 1,2 陳昆輝 1 潘建州 1 金寧建 1 石承民 1 吳蘊哲 1 李政鴻 1
單位(Organization)台中榮民總醫院骨科部 1 光田綜合醫院骨科部 2
【Introduction】
Spondylolisthesis and degenerative disc disorder in adults are most common cause of lumbar surgery. There
are many surgical options and the interbody fusion is the most common technique and has shown satisfactory
results. But solid fusion has been reported to accelerate degenerative changes at adjacent segment and sagittal
alignment of the fusion segments also influences the adjacent segments stresses and affects the degeneration
rate. The anterior and oblique lumbar interbody fusion cages has lordotic angle and reported restore the index
segment lordosis for prevent the adjacent segment degeneration. The purpose of this study was to compare
morphology change of adjacent disc in patients who had received the anterior lumbar interbody fusion and
oblique lumbar interbody fusion.
【Results】
The 47 patients include 23 cases received the ALIF and 24 cases received the OLIF. All 47 cases the index
lordosis had significant increase after post-op one year follow up. The adjacent disc anterior and posterior disc
height also decrease after post-op one month follow up significantly, but after follow up to one year, no
significantly decrease. In the ALIF group, the index lordosis significant increase after post-op one year. The
adjacent disc height only anterior disc height significant decrease after post-op one month follow up. In the
OLIF group, the anterior and posterior adjacent disc height were significant decrease after post-op one year
follow up. Both group the adjacent disc angle no significant change after surgery follow up.
【Discussion】
After the spinal fusion surgery without restore the lordosis, the adjacent segment degeneration will occur and
flat back deformity also developed. We know that the ALIF and OLIF are lordotic cages and can restore the
lordosis at index level. In our hypothesis, the adjacent disc can prevent degeneration and compensative lordosis
change after ALIF or OLIF surgery. The result revealed that after surgery, the index angle increased and the
adjacent disc angle did not change. Although, the adjacent disc height decreased after ALIF and OLIF, no
progressive decreasing was noted after follow up to one year. We found that index angle was significant change
in ALIF than OLIF, we thought that the anterior longitudinal ligament was released in ALIF surgery and
increase the anterior disc height at index level. Due to the anterior longitudinal ligament not released at OLIF
surgery, the index level pressure was high and cause the cages subsidence after surgery and lordosis increasing
not significant at index level.
【Conclusions】
In our study, after the ALIF or OLIF surgery the adjacent disc angle did not change and anterior disc height
decrease significant. But posterior disc height only decrease after OLIF. The index lordosis only significant
after ALIF surgery. We suggest that ALIF can maintain good lordosis and prevent the adjacent disc height
decrease and compensate shape change. OLIF also prevent the adjacent disc angle change for compensate, but
the disc height can not preserved after surgery.