Hospital for Special Surgery, New York, NY, USA.
Spine (Phila Pa 1976). 2012 Oct 15;37(22 Suppl):S65-74. doi: 10.1097/BRS.0b013e31826cb8f5.
Systematic review.
To answer the following clinical questions: (1) What is the risk of adjacent-level ossification development (ALOD) in patients receiving noninstrumented cervical fusion, instrumented cervical fusion with a plate, or cervical total disc arthroplasty?; (2) What are the risk factors for ALOD?; (3) What is the time course for the development of ALOD?; and (4) Does ALOD affect outcomes and rates of reoperation?
Anterior cervical plating, total disc arthroplasty, and noninstrumented fusion have all been used in the treatment of cervical disc disease. There are numerous reports that identify ALOD, a form of heterotopic ossification, as a major risk factor after performing these procedures. Few studies have compared these 3 procedures to evaluate the risk, timing, and outcomes related to postoperation ALOD.
A systematic search was conducted in PubMed and the Cochrane Library for articles published between January 1, 1990, and December 31, 2011. We included all articles that described the risk of or risk factors for ALOD after surgical treatment of the cervical spine. Studies with patients older than 18 years or those treated for tumor or trauma were excluded from the study. In addition, those with posterior fusions, case reports, and case series with less than 10 patients were excluded.
A total of 5 studies met the inclusion criteria for our systematic review. The risk of ALOD with anterior cervical discectomy and fusion ranged from 41% to 64%, whereas the risk of ALOD after total disc replacement ranged from 6% to 24%. When ALOD did occur, there was a 2-fold higher risk of development at the cranial adjacent segment. The most important risk factor for the development of ALOD was the use of instrumentation and the plate-to-disc distance, although the surgical procedure type (corpectomy vs. discectomy and fusion) neared but did not reach statistical significance. Insufficient evidence was available to delineate the time course for its development and how ALOD affected outcomes.
The current body of literature suggests that ALOD will develop with the use of instrumentation and especially so if anterior instrumentation is placed within 5 mm of the adjacent cranial disc segment. In addition, total disc replacement showed lower rates for the development of ALOD compared with anterior cervical discectomy and fusion at both short- and long-term follow-up.
We recommend that the surgeon make every effort to keep the plate as far away from the adjacent disc as possible. Strength of Statement: Strong.
系统评价。
回答以下临床问题：（1）接受非器械性颈椎融合、器械性颈椎融合加板或颈椎全椎间盘置换的患者发生邻近节段骨化（ALOD）的风险如何？（2）ALOD 的风险因素有哪些？（3）ALOD 的发展时间过程如何？（4）ALOD 是否会影响结果和再次手术的发生率？
前路颈椎板固定、全椎间盘置换和非器械性融合均已用于治疗颈椎间盘疾病。有大量报告表明，在进行这些手术后，ALOD（一种异位骨化形式）是主要的风险因素。很少有研究比较这 3 种手术来评估与术后 ALOD 相关的风险、时间和结果。
在 PubMed 和 Cochrane 图书馆中对 1990 年 1 月 1 日至 2011 年 12 月 31 日期间发表的文章进行了系统搜索。我们纳入了描述颈椎手术后 ALOD 风险或风险因素的所有文章。排除了年龄大于 18 岁或因肿瘤或创伤而接受治疗的患者的研究。此外，还排除了后路融合、病例报告和每个病例少于 10 例的病例系列研究。
共有 5 项研究符合我们系统评价的纳入标准。前路颈椎间盘切除融合术的 ALOD 风险为 41%至 64%，而全椎间盘置换术的 ALOD 风险为 6%至 24%。当 ALOD 确实发生时，在颅侧相邻节段发生的风险增加了 2 倍。ALOD 发展最重要的风险因素是使用器械和板-椎间盘的距离，尽管手术类型（椎体切除术与椎间盘切除术和融合术）接近但未达到统计学意义。目前尚无足够证据来描述其发展时间过程以及 ALOD 如何影响结果。
目前的文献资料表明，使用器械会导致 ALOD 发展，尤其是在前路器械距离相邻颅侧椎间盘段 5mm 以内时。此外，在短期和长期随访中，全椎间盘置换术与前路颈椎间盘切除融合术相比，发生 ALOD 的发生率较低。
我们建议外科医生尽最大努力使板尽可能远离相邻的椎间盘。声明强度：强。
