요추부 후외방 유합술 후 수술적 치료를 요하는 불 유합의 위험 인자 = Risk Factors of Nonunion Demanding Surgical Treatment after Lumbar Posterolateral Fusion

다국어 초록 (Multilingual Abstract)

Study Design: This is a retrospective study for radiographically and clinically assessing nonunion after lumbar spine fusion.
Objectives: We wanted to analyze the risk factors for nonunion that requires surgical treatment after lumbar spine fusion Summary of the Literature Review: A diagnosis of the nonunion after lumbar spine fusion was made by using only the only radiologic images. The incidence of nonunion has been underreported because there are many asymptomatic patients.
Materials and Methods: The plain X-ray films were evaluated for 1317 patients who could be followed up more than 1 year after lumbar fusion. Nonunion was diagnosed at 1 year after fusion by instability seen on the flexion-extension radiograph and the clinical findings like as sustained pain and local tenderness at the surgical site. The risk factors we reviewed included age, the number of levels fused, associated diseases, smoking, alcohol drinking, the initial diagnosis, a previous history of spinal operation, infection, a clear zone and malposition of pedicle screws and metal failure. The relations between nonunion and the factors mentioned above were analyzed.
Results: Thirty-nine patients were diagnosed as having nonunion underwent reoperation and all had surgically confirmed nonunion.
Smoking, infection and a previous history of spine operation had a significant influence on nonunion (p < 0.05). Clear zones persisting more than 1 year and metal failure also had a significant influence on nonunion (p < 0.05). Age, the number of fused levels, the initial diagnosis and alcohol drinking were not shown to influence the rate of nonunion (p < 0.05).
Conclusion: A through clinical and radiologic evaluation is essential to diagnose nonunion, and this should not be done according to the radiologic images only. Risk factors such as a previous history of spine operation, infection, smoking, the development of a clear zone and metal failure all showed a statistically significant influence on nonunion. Additionally, preoperative and postoperative evaluation of these parameters is needed to achieve bone union.

국문 초록 (Abstract)

연구 계획: 요추부 후외방 유합술 후 수술적 치료를 요하는 불유합에 대한 후향적 연구목적: 본 연구는 요추부 후외방 유합술 후 발생한 불유합으로 재수술을 시행한 환자들을 대상으로 불유합과 관련된 위험 인자를 분석하여 보고하고자한다.
선행 문헌의 요약: 요추부 유합술 후 불유합의 진단은 방사선 사진만으로 평가되어져 왔다. 불유합의 발생율은 많은 무증상 환자들로 인해 적게 보고되고 있는 실정이다.
대상 및 방법: 요추부의 후외방 유합술을 시행 받고 1년 이상 추시 관찰이 가능했던 1317명을 대상으로 방사선 사진을 분석하였다. 불유합은 유합술 시행 1년 후 굴곡 신전 방사선 검사상 추체간의 움직임 및 수술 부위의 국소 동통과 통증이 동반되는 경우로 정의하였다. 불유합으로 진단된 39명에서 재수술을 시행하였고, 불유합과 나이, 수술 받은 척추 분절 수, 동반 질환, 흡연, 음주, 최초 수술시 진단, 이전 척수 수술 여부, 수술 부위 감염, 방사선 투과대 발생, 척추경 나사의 이상 위치 및 금속 실패와의 관련성을 분석하였다.
결과: 재수술을 시행한 39명에서 모두 불유합이 확인되었다. 불유합은 흡연자군, 술 후 감염이 발생한 군 및 척추 수술 과거력이 있는 군에서 더 많았고각각은 통계학적으로 유의하였다(p < 0.05). 그리고 1년째 지속적으로 방사선 투과대 양성인 경우 및 금속 실패와 불유합 발생 간에도 통계학적으로 유의한 결과가 나타났다( p < 0.05). 나이, 수술 받은 척추 분절 수, 진단명, 그리고 음주 간에는 통계학적 유의성이 없었다(p > 0.05).
결론: 기존의 방사선 사진만으로 불유합을 정의하는 것은 제한점이 있어 임상 증상을 진단에 추가하는 것이 바람직할 것으로 생각된다. 또한 이전 척추수술 여부, 감염, 흡연, 방사선 투과대 발생 및 금속 실패 등의 경우에서 불유합 발생률이 유의하게 높았으며, 골유합 획득을 위해 이런 인자들에 대한 술전, 술 후 평가가 충분히 고려되어야 할 것으로 사료된다.

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