The Clinical Efficacy Observation On The Prevention Of Adjacent Segment Degeneration After Lumbar Fusion With Progressive Functional Exercise

Objective:Referring to the chapter Adult Lumbar Fusion from the Postsurgical Rehabilitation Guidelines for the Orthopedic Clinician,the author sum up with a series of functional exercise from simple to complicated.Meanwhile,comparing with the low-back-muscle functional exercise of PLA 175th Hospital,to observe the adjacent segment degeneration after lumbar fusion of two groups of patients through above two exercise method.Methods:Sampling 60 female patient in the Department of Orthopedics of PLA 175th Hospital from August 2015 to January 2016,who were treated with posterior internal fixation of lumbar intervertebral + lumbar fusion.Randomly divide the 60 patients into two group:30 to take progressive functional exercise in test group and 30 to low-back-muscle functional exercise in control group.All patients have learn the progressive functional exercise and basic low-back-muscle exercise before and after surgery regularly return to hospital for inspection and correction of their exercise movements.Doctors have followed up their complete status after leaving hospital by phone calls or wechat app.In the last preoperative and postoperative follow-up MRI patients were inspected with MRI inspection and recorded by X-ray pictures of L-Shine PA&LAT and Spine Dynamic.Evaluated the patients with VAS and ODI when before surgery,sixth weeks,3 months,6 months and 1 year after forgery.Measuring the intervertebral height of adjacent segment,intervertebral angle,vertebral slip,cross-sectional area of paravertebral muscle(psoas muscle,erector spinae,multiple split muscle),and spinal stenosis by ZWCAD+ software to record the data changes.Assessing the adjacent segment degeneration before and after operation by Pfirrmann method.Results:All patients met the inclusion criteria and completed 1 years of follow-up.There was no significant difference in age,weight,height,and BMI index before surgery.Postoperative VAS score and ODI score of two groups of patients was significantly lower than that before operation.The VAS score and ODI score of test group in 6 weeks and 3 months after surgery decreased significantly,comparing with control group(P<0.05).In the decline of the height of the intervertebral disc,vertebral slip,intervertebral angle,the two groups of patients with different degrees of degeneration,and the experimental group than the control group,the degree of light degeneration,the difference was statistically significant(P<0.05).Both groups of patients had degeneration in different level on the aspect such as decline of intervertebral height,vertebral slip and intervertebral angle.However,test group had a more little degeneration(P<0.05).By the postoperative functional exercise,the cross-sectional area of paravertebral muscle of both groups of patients had increased in different level,And the increase of test group was larger than control group.There was no obvious degeneration of intervertebral disc after surgery of both groups.But spinal canal stenosis changed in different level,while test group's change was slighter than control group.Conclusion:1.Progressive functional exercise can significantly relieve the early symptoms after operation of low back pain and improve the lumbar function,which can prevent adjacent segment degeneration(ASDeg)in some degrees;2.A progressive functional exercise from easy to difficult and simple to complex can help to many parts of low-back muscle get exercised.And it has a better effect than low-back functional muscle exercise on relieving the early symptoms after operation of low back pain and improving the lumbar function.