融合还是非融合脊柱手术的争论PPT课件.pptVIP

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Interbody graft Interbody fusion mush in cervical spine Interbody fusion cage in lumbar spine Advantages of Fusion Spine obtains reliable sequential stability, because several unstable segments are fused to a whole, risk factors which results in constructive instability are eliminated. As a whole, there are no movement among fused segments, thus, dynamic instability is reversed. As a result, neural stability and painful stabilty can be achieved. Study showed that spinal fusion is able to reduce pain and improve function in patients with chronic low back pain. Disadvantages of Fusion Lower the spinal mobility Normal spinal mobility Spinal mobility are dispersed to each motion unit. Because fused motion unit can not move anymore, lumbar spinal mobility will be lowered. Consequently, life quality will be lowered. Disadvantages of Fusion Lower the spinal mobility Single segment fusion Multi-segments fusion Atlas-axis (C1-2) fusion Disadvantages of Fusion Adjacent segment degeneration Because fused segment lose its motion, the adjacent segments (upper one and lower one) take place its function, which results load increase of the adjacent segments. Consequently, the adjacent segments degenerated more quickly. This is called ASD (adjacent segment degeneration) X-ray: ① intervertebral space narrow ? formation of osteophyte ③ instability Disadvantages of Fusion Adjacent segment degeneration Disadvantages of Fusion Adjacent segment degeneration ASD? maybe just natural history The patient has the susceptible factors, the intervertebra disc is easy to degenerat, no matter it is fused or not. I compared ASD rate of fusion group wit