Department of Orthopaedics, Southern Health, Dandenong Hospital, 135 David Street, Dandenong, VIC 3175, Australia.
Department of Neurosurgery, Austin Hospital and Cabrini Hospital, Melbourne, VIC, Australia.
J Clin Neurosci. 2014 Jan;21(1):82-5. doi: 10.1016/j.jocn.2013.02.039. Epub 2013 Sep 11.
Anterior cervical discectomy and fusion (ACDF) is a widely accepted surgical treatment for symptomatic cervical spondylosis. Some patients develop symptomatic adjacent segment degeneration, occasionally requiring further treatment. The cause and prevalence of adjacent segment degeneration and disease is unclear at present. Proponents for motion preserving surgery such as disc arthroplasty argue that this technique may decrease the "strain" on adjacent discs and thus decrease the incidence of symptomatic adjacent segment degeneration. The purpose of this study was to assess the pre-operative prevalence of adjacent segment degeneration in patients undergoing ACDF. A database review of three surgeons' practice was carried out to identify patients who had undergone a one- or two-level ACDF for degenerative disc disease. Patients were excluded if they were operated on for recent trauma, had an inflammatory arthropathy (for example, rheumatoid arthritis), or had previous spine surgery. The pre-operative MRI of each patient was reviewed and graded using a standardised methodology. One hundred and six patient MRI studies were reviewed. All patients showed some evidence of intervertebral disc degeneration adjacent to the planned operative segment(s). Increased severity of disc degeneration was associated with increased age and operative level, but was not associated with sagittal alignment. Disc degeneration was more common at levels adjacent to the surgical level than at non-adjacent segments, and was more severe at the superior adjacent level compared with the inferior adjacent level. These findings support the theory that adjacent segment degeneration following ACDF is due in part to the natural history of cervical spondylosis.
颈椎前路椎间盘切除融合术 (ACDF) 是一种广泛接受的治疗颈椎病症状的手术方法。一些患者会出现症状性相邻节段退变，偶尔需要进一步治疗。目前，相邻节段退变和疾病的原因和流行程度尚不清楚。提倡采用椎间盘置换等保留运动技术的支持者认为，这种技术可能会减轻相邻椎间盘的“张力”，从而降低症状性相邻节段退变的发生率。本研究旨在评估接受 ACDF 手术的患者术前相邻节段退变的患病率。对三位外科医生的手术实践进行了数据库回顾，以确定因退行性椎间盘疾病接受一或两水平 ACDF 的患者。如果患者因近期外伤、炎性关节炎（例如类风湿关节炎）或先前的脊柱手术而接受手术，则将其排除在外。对每位患者的术前 MRI 进行了回顾，并使用标准化方法进行了分级。共回顾了 106 例患者的 MRI 研究。所有患者在计划手术节段相邻的部位都显示出一定程度的椎间盘退变证据。椎间盘退变的严重程度与年龄和手术水平增加有关，但与矢状位排列无关。与非相邻节段相比，手术水平相邻节段的椎间盘退变更为常见，且上相邻节段的退变比下相邻节段更为严重。这些发现支持了 ACDF 后相邻节段退变部分是由于颈椎病自然史的理论。
