颈椎前路融合术后需要再次手术的相邻节段病变：吸烟、性别及手术节段数量的影响
Adjacent segment pathology requiring reoperation after anterior cervical arthrodesis: the influence of smoking, sex, and number of operated levels.
作者信息
Lee Jae Chul, Lee Sang-Hun, Peters Colleen, Riew K Daniel
机构信息
*Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea †Department of Orthopedic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea; and ‡Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO.
出版信息
Spine (Phila Pa 1976). 2015 May 15;40(10):E571-7. doi: 10.1097/BRS.0000000000000846.
STUDY DESIGN
A retrospective study.
OBJECTIVE
The purpose of this study was to determine, using survivorship analysis, the rate of adjacent segment pathology (ASP) development and to identify the risk factors for reoperation.
SUMMARY OF BACKGROUND DATA
The study of Hilibrand defined "adjacent segment disease" as symptomatic radiculopathy or myelopathy due to an adjacent segment documented on 2 consecutive office visits. In addition to being somewhat subjective, their criterion is not as practical as identifying the rate of adjacent pathology by the need for reoperation.
METHODS
This was a retrospective analysis of 1038 consecutive patients who underwent primary anterior cervical spine arthrodesis for radiculopathy and/or myelopathy by 1 surgeon. Annual incidence and prevalence of ASP requiring surgery were calculated and survivorship was determined. We used the Cox regression for risk factor analysis.
RESULTS
Secondary surgery on adjacent segments occurred at a relatively constant rate of 2.4% per year (95% confidence interval, 1.9-3.0). The Kaplan-Meier analysis predicted that 22.2% of patients would need reoperation at adjacent segments by 10 years postoperatively. Factors increasing the risk were smoking, female sex, and the number of arthrodesis segments. One or 2-segment arthrodesis had an 1.8 times greater risk than arthrodesis involving 3 or more segments. Age, neurological diagnosis, diabetes, Klippel-Feil syndrome, and noncontiguous segmental-type ossification of posterior longitudinal ligament were not significant risks.
CONCLUSION
Patients treated with 1- or 2-segment anterior cervical arthrodesis are more likely to develop ASP than those treated with arthrodesis involving 3 or more segments. Smokers and women had a higher ASP reoperation rate. Our series, the largest in the literature, predicts that 22.2% of patients will require reoperation for ASP within 10 years, substantially higher than the Hilibrand study.
LEVEL OF EVIDENCE
研究设计
一项回顾性研究。
目的
本研究的目的是使用生存分析确定相邻节段病变（ASP）的发生率，并识别再次手术的风险因素。
背景数据总结
Hilibrand的研究将“相邻节段疾病”定义为因在连续两次门诊就诊时记录到的相邻节段出现的有症状的神经根病或脊髓病。除了有点主观外，他们的标准不如通过再次手术需求来确定相邻节段病变发生率那样实用。
方法
这是一项对1038例连续患者的回顾性分析，这些患者均由1名外科医生因神经根病和/或脊髓病接受了初次颈椎前路融合术。计算了需要手术的ASP的年发病率和患病率，并确定了生存率。我们使用Cox回归进行风险因素分析。
结果
相邻节段的二次手术发生率相对稳定，为每年2.4%（95%置信区间，1.9 - 3.0）。Kaplan-Meier分析预测，术后10年时22.2%的患者需要对相邻节段进行再次手术。增加风险的因素包括吸烟、女性以及融合节段的数量。单节段或双节段融合术的风险比涉及3个或更多节段的融合术高1.8倍。年龄、神经学诊断、糖尿病、Klippel-Feil综合征以及后纵韧带非连续性节段型骨化不是显著风险因素。
结论
接受单节段或双节段颈椎前路融合术治疗的患者比接受涉及3个或更多节段融合术治疗的患者更易发生ASP。吸烟者和女性的ASP再次手术率更高。我们的系列研究是文献中规模最大的，预测22.2%的患者在10年内将因ASP需要再次手术，显著高于Hilibrand的研究。
证据级别
3级。
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