Department of Orthopaedics, Traditional Chinese Medical Hospital of Nantong City, Nantong, Jiangsu, China.
Spine (Phila Pa 1976). 2013 Apr 1;38(7):597-608. doi: 10.1097/BRS.0b013e318273a2ea.
Systematic review of published prevalence of adjacent segment degeneration (ASD) after spine surgery.
To evaluate the prevalence of ASD in patients after cervical and lumbar spine surgery.
ASD is a common complication after spine surgery in long-term follow-up. A large body of literature has been reported on the topic, but no meta-analysis of the epidemiological data on ASD has been published
We searched the MEDLINE until March 2012 published in English language that reported the prevalence of ASD after spine surgery. We determined the ASD rates by calculating proportions and 95% confidence interval (CI) for each study and then pooled the data to derive a pooled proportion and 95% CI.
A total of 94 studies with 34,716 patients from 19 countries were included. The occurrence of radiograph ASD ranged from 4.8% to 92.2%, and the pooled prevalence was 29.3% (95% CI, 22.7%-35.8%) by the random-effects model. The occurrence of symptoms ASD ranged from 0.0% to 30.3%, and the pooled prevalence was 7.4% (95% CI, 6.4%-8.5%). In cervical position, the occurrence of radiograph ASD and symptoms ASD was 32.8% (95% CI, 17.8%-47.9%) and 6.3% (95% CI, 4.8%-7.8%); in lumbar position, the occurrence of radiograph ASD and symptoms ASD was 26.6% (95% CI, 21.3%-31.9%) and 8.5% (95% CI, 6.4%-10.7%). In the 0.5- to 2- or less, more than 2- to 5- or less, and more than 5- to 20- or less year diagnosis time, the radiograph ASD prevalence was 21.8% (16.0%-27.6%), 33.6% (21.8%-45.4%), and 37.4% (10.7%-64.1%), respectively; and the symptoms ASD prevalence was 6.5% (4.8%-8.1%), 12.1% (8.2%-16.0%), and 3.2% (2.5%-4.0%), respectively.
Spine surgery is associated with significant risk of ASD. These figures may be useful in the estimation of the burden of the ASD after spine surgery.
对已发表的脊柱手术后邻近节段退变（ASD）发生率的系统评价。
评估颈椎和腰椎手术后 ASD 在患者中的发生率。
ASD 是脊柱手术后长期随访中常见的并发症。大量文献报道了这一主题，但尚未发表过关于 ASD 流行病学数据的荟萃分析。
我们检索了截至 2012 年 3 月 MEDLINE 发表的英文文献，报道了脊柱手术后 ASD 的发生率。我们通过计算每个研究的比例和 95%置信区间（CI）来确定 ASD 发生率，然后汇总数据以得出汇总比例和 95%CI。
共纳入来自 19 个国家的 94 项研究，共 34716 例患者。影像学 ASD 的发生率为 4.8%至 92.2%，随机效应模型汇总的患病率为 29.3%（95%CI，22.7%-35.8%）。症状性 ASD 的发生率为 0.0%至 30.3%，汇总患病率为 7.4%（95%CI，6.4%-8.5%）。在颈椎位置，影像学 ASD 和症状性 ASD 的发生率分别为 32.8%（95%CI，17.8%-47.9%）和 6.3%（95%CI，4.8%-7.8%）；在腰椎位置，影像学 ASD 和症状性 ASD 的发生率分别为 26.6%（95%CI，21.3%-31.9%）和 8.5%（95%CI，6.4%-10.7%）。在诊断时间为 0.5-2 年或更短、2-5 年或更短和 5-20 年或更短的情况下，影像学 ASD 的患病率分别为 21.8%（16.0%-27.6%）、33.6%（21.8%-45.4%）和 37.4%（10.7%-64.1%）；症状性 ASD 的患病率分别为 6.5%（4.8%-8.1%）、12.1%（8.2%-16.0%）和 3.2%（2.5%-4.0%）。
脊柱手术与 ASD 发生的风险显著相关。这些数据可能有助于估计脊柱手术后 ASD 的负担。
