Kaye I David, David Kaye I, Hilibrand Alan S
Rothman Institute at Thomas Jefferson University Hospital, 925 Chestnut Street, Philadelphia, PA, 19107, USA.
Curr Rev Musculoskelet Med. 2017 Jun;10(2):147-152. doi: 10.1007/s12178-017-9396-5.
The precise etiology of adjacent segment disease following cervical spine surgery is controversial. Theories for development include inevitable changes secondary to the natural progression of the degenerative cascade and changes secondary to altered biomechanics of the fused cervical spine. Motion preserving techniques, such as cervical disc arthroplasties (CDA), have been introduced with the hopes of reducing the rates of adjacent segment pathology. Recently, 7-year data from the investigational device exemption (IDE) studies have been published. The purpose of this review is to provide an update on cervical adjacent segment disease incorporating this emerging data into the analysis.
Although the 7-year data for CDA has confirmed continued success, specifically regarding improved neck pain and reduced re-operation rates, the influence of CDA on reducing rates of adjacent segment pathology remains questionable. Although some studies have found more radiographic adjacent segment disease after anterior cervical discectomy and fusion (ACDF) compared to CDA, an association between these findings and clinical symptoms has not been established. Cervical disc arthroplasty continues to outperform cervical disc fusion regarding some patient specific parameters, however, whether CDA reduces rates of radiographic and clinical adjacent segment pathology remains unknown. Without studies developed specifically to address this question, the answer remains elusive.
颈椎手术后相邻节段疾病的确切病因存在争议。其发病理论包括退变级联反应自然进展继发的不可避免变化以及颈椎融合后生物力学改变继发的变化。诸如颈椎间盘置换术（CDA）等保留运动功能的技术已被引入，以期降低相邻节段病变的发生率。最近，来自研究性器械豁免（IDE）研究的7年数据已公布。本综述的目的是结合这些新出现的数据，对颈椎相邻节段疾病进行分析并提供最新情况。
尽管CDA的7年数据证实了其持续的成功，特别是在改善颈部疼痛和降低再次手术率方面，但CDA对降低相邻节段病变发生率的影响仍存在疑问。尽管一些研究发现，与CDA相比，前路颈椎间盘切除融合术（ACDF）后影像学上的相邻节段疾病更多，但这些发现与临床症状之间的关联尚未确立。在一些患者特定参数方面，颈椎间盘置换术继续优于颈椎间盘融合术，然而，CDA是否能降低影像学和临床相邻节段病变的发生率仍不清楚。由于没有专门针对这个问题开展的研究，答案仍然难以捉摸。
