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腰椎邻近节段退变是指腰椎手术后手术节段头端或尾端发生的退行性改变,其中一部分患者同时出现相应的临床症状,称之为邻近节段疾病.近年来虽然有非常多的新技术涌现,但邻近节段退变并未真正得到解决.通过对MEDLINE/PubMed 、Cochrane Controlled Trials Registry 、EMBASE数据库进行检索,纳入所有使用融合和(或)固定、单纯减压或人工腰椎间盘置换三种手术治疗腰椎退行性疾病的随机或非随机临床研究,同时保证纳入研究的病例数量≥20例及患者年龄≥18岁.排除个案报道、综述或荟萃分析、无法获得摘要的文献,以及创伤、感染、肿瘤和炎症性疾病的研究.主要针对邻近节段退变的定义及诊断标准,以及邻近节段退变及再手术的发生率和危险因素进行综述.文献中邻近节段退变的概念在使用上较为混乱,影像学上退变同症状性退变常常混杂使用,因此对文献间进行横向比较得出结论较为困难.此外,既往研究并未全面了解邻近节段退变的发病机制及危险因素,特别是手术节段对邻近节段的影响.且目前文献报道的结果多为回顾性研究所得,尚缺乏高等级证据.腰椎融合术后再手术的主要原因是邻近节段退变,降低再手术率最主要的方法就是降低邻近节段退变的发生率.应首先统一邻近节段退变的诊断标准,同时对包括手术节段在内的各种因素进行全面研究,通过高等级证据阐明邻近节段退变的发生机制和危险因素.“,”Lumbar adjacent segment degeneration is defined as degenerative changes cranial or caudal to surgical segments.Some patients developed corresponding clinical symptoms in addition to radiological degeneration,which is called adjacent segment disease.Although many new surgical techniques emerged in recent years,the problem of adjacent segment degeneration has not really been resolved.MEDLINE/PubMed,Cochrane Controlled Trials Registry and EMBASE were comprehensively searched.All randomized or nonrandomized clinical studies of lumbar degenerative diseases treated by fusion/fixation,decompression-alone or artificial lumbar disc replacement were included.The number of cases enrolled in these studies was greater than or equal to 20 cases and the minimum age of the patients was 18 years old.Case reports,reviews or meta-analyses,papers with unobtainable text and abstract,and studies of trauma,infection,oncology and inflammatory disease were all excluded.The diagnostic criteria of adjacent segment degeneration,as well as the incidence and risk factors of adjacent segment degeneration and reoperation were reviewed.The concepts of adjacent segment degeneration in different literatures were very confusing,and radiological degeneration was often mixed in use with symptomatic degeneration.It was therefore difficult to make any conclusion due to lack of a standard.In addition,the previous studies did not fully understand the pathogenesis and risk factors of the disease,especially the effect of the index level on adjacent segments.Moreover,most of the current studies were retrospective,therefore,convincing conclusions can hardly be drawn due to lack of high-level evidence.The main reason for reoperation after lumbar fusion is adjacent segment degeneration.Therefore,the most important way to reduce the rate of reoperation is to reduce the incidence of adjacent segment degeneration.In the future,the diagnostic criteria for adjacent segment degeneration should be unified first.And it is extremely important to thoroughly understand the mechanism and risk factors of adjacent segment degeneration by comprehensive studies and clarify them through high-level evidence.