Li Jia, Li Yongqian, Kong Fanlong, Zhang Di, Zhang Yingze, Shen Yong
Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang 050051, PR China; The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, PR China.
Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang 050051, PR China; The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, PR China.
J Clin Neurosci. 2015 Mar;22(3):566-9. doi: 10.1016/j.jocn.2014.08.019. Epub 2014 Dec 5.
The purpose of this study was to find whether excessive distraction of the disc space for cage insertion was a risk factor for adjacent segment degeneration (ASD) after anterior cervical decompression and fusion (ACDF). One hundred and sixteen consecutive patients who underwent ACDF for single-level cervical disc herniation between June 2006 and November 2008 were retrospectively reviewed. Preoperative, postoperative and final follow-up disc height (DH), sagittal segmental alignment (SSA), and sagittal alignment of the cervical spine (SACS) were measured and compared between the ASD group and non-ASD group. In 116 patients, ASD was radiographically proven in 28 (24.1%) patients. The clinical outcomes were significantly improved compared to the preoperative scores in both groups. However, the postoperative and final follow-up DH of the ASD group were significantly higher than in the non-ASD group (p<0.05). In addition, the postoperative DH was significantly correlated with the postoperative or final follow-up SSA (p<0.05). However, postoperative DH was not found to significantly correlate with postoperative or final follow-up SACS (p=0.072 and p=0.096, respectively). Multivariate analysis showed that postoperative DH was the most significant risk factor for ASD. The clinical outcomes of ACDF for single-level degenerative cervical disc disease were satisfactory. Postoperative DH (the distracted distance) had the greatest impact on the incidence of ASD. Excessive disc space distraction is a considerable risk factor for the development of radiographic ASD.
本研究的目的是探究在颈椎前路减压融合术（ACDF）后，椎间融合器植入时椎间盘间隙过度撑开是否为相邻节段退变（ASD）的危险因素。回顾性分析了2006年6月至2008年11月期间连续116例行单节段颈椎间盘突出症ACDF手术的患者。测量并比较了ASD组和非ASD组术前、术后及末次随访时的椎间盘高度（DH）、矢状节段对线（SSA）和颈椎矢状对线（SACS）。116例患者中，28例（24.1%）经影像学证实发生ASD。两组患者的临床结局均较术前评分有显著改善。然而，ASD组术后及末次随访时的DH显著高于非ASD组（p<0.05）。此外，术后DH与术后或末次随访时的SSA显著相关（p<0.05）。然而，未发现术后DH与术后或末次随访时的SACS显著相关（分别为p=0.072和p=0.096）。多因素分析显示，术后DH是ASD最显著的危险因素。单节段退变性颈椎间盘疾病ACDF的临床结局令人满意。术后DH（撑开距离）对ASD的发生率影响最大。椎间盘间隙过度撑开是影像学ASD发生的一个重要危险因素。
