Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China.
Laboratory of Molecular Biology, Center of Experimental Animals, Hebei Medical University, Shijiazhuang, 050017, China.
Sci Rep. 2017 Nov 27;7(1):16443. doi: 10.1038/s41598-017-16670-1.
Based on long-term follow-ups, this study was designed to investigate the incidence and risk factors for postoperative adjacent segment degeneration (ASD) after anterior cervical discectomy and fusion (ACDF) or total disc replacement (TDR) in treating cervical degenerative diseases. Between January 2000 and December 2005, 108 cases undergoing ACDF and 78 undergoing TDR, were enrolled into this study. All medical records were retrospectively collected. Every patient was followed up at least 10 years. Outcome assessment included visual analogue scale (VAS) score, Neck Disability Index (NDI) score, Japanese Orthopaedic Association (JOA) score, and radiographic parameters. Consequently, thirty-eight (35.2%) of 108 cases suffered from ASD in ACDF group, and 26 (33.3%) of 78 cases in TDR group. There was no statistical difference between the two groups regarding ASD incidence, VAS/NDI/JOA score, recovery rate. Logistic regression analysis showed that age (OR = 2.86, 95% CI, 1.58-4.14) and preoperative segmental lordosis (OR = 1.90, 95% CI, 1.05-3.20) were risk factors associated with increased odds of ASD regardless of surgical procedures. On the other hand, preoperative overall lordosis (OR = 0.54, 95% CI, 0.26-0.82) was most likely protective. In conclusion, advanced age and preoperative segmental lordosis were identified as risk factors for postoperative ASD, while preoperative overall lordosis proves to be a protective factor.
基于长期随访结果，本研究旨在调查颈椎退行性疾病行前路颈椎间盘切除融合术（ACDF）或全椎间盘置换术（TDR）后发生术后邻近节段退变（ASD）的发生率及相关危险因素。2000 年 1 月至 2005 年 12 月，纳入 108 例行 ACDF 和 78 例行 TDR 的患者。回顾性收集所有病历，所有患者均至少随访 10 年。结果评估包括视觉模拟评分（VAS）、颈部残疾指数（NDI）评分、日本骨科协会（JOA）评分和影像学参数。结果显示，ACDF 组中有 38 例（35.2%）发生 ASD，TDR 组中有 26 例（33.3%）发生 ASD，两组 ASD 发生率、VAS/NDI/JOA 评分、恢复率差异无统计学意义。Logistic 回归分析显示，年龄（OR=2.86，95%CI，1.58-4.14）和术前节段前凸（OR=1.90，95%CI，1.05-3.20）是与 ASD 发生风险增加相关的独立危险因素，而与手术方式无关。另一方面，术前总体前凸（OR=0.54，95%CI，0.26-0.82）是最可能的保护因素。总之，高龄和术前节段前凸被确定为术后 ASD 的危险因素，而术前总体前凸是保护因素。
