Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
Department of Orthopaedic Surgery, Takeda General Hospital, 3-27 Yamaga-machi, Aizu-Wakamatsu, Fukushima, 965-8585, Japan.
Int Orthop. 2019 Apr;43(4):987-993. doi: 10.1007/s00264-018-4241-z. Epub 2018 Nov 23.
Adjacent segment degeneration (ASDeg) and disease (ASDis) have become major concerns after fusion surgery. However, there is no definitive data or knowledge about the incidence or risk factors. The review discusses the incidence and risk factors and prevention of ASDeg and ASDis in the relevant literature.
We performed a systematic review of meta-analyses, randomized control trials, and cohort studies published in English to provide evidence-based information about ASDeg and ASDis.
According to a meta-analysis, the pooled incidence of ASDeg after lumbar and cervical fusion surgery was 26.6% and 32.8%, respectively. Approximately 1/4-1/3 of ASDeg progressed to ASDis. Risk factors after cervical fusion surgery were young age, pre-existing disc degeneration, short fusion segment, high T1 slope, disruption of adjacent soft tissue, and plate placement close to the adjacent disc. The risk factors of ASDeg and ASDis after lumbar fusion surgery were age, genetic factors, high body mass index, pre-existing adjacent segment degeneration, laminectomy at the adjacent level of fusion, excessive distraction of the fusion level, insufficient lumbar lordosis, multilevel fixation, floating fusion, coronal wedging of L5-S disc, pelvic tilt, and osteoporosis. Motion-preserving surgeries seem to have less risk of ASDeg and ASDis than conventional fusion surgery both in the lumbar and cervical spine.
The existent literature points out variables involved in ASDeg and ASDis. High evidence-level studies should provide more relevant data to guide strategies for avoiding ASDeg and ASDis.
融合手术后，相邻节段退变（ASDeg）和疾病（ASDis）已成为主要关注点。然而，关于其发病率或危险因素尚无明确数据或知识。本综述讨论了相关文献中 ASDeg 和 ASDis 的发病率和危险因素以及预防措施。
我们对发表于英文期刊的荟萃分析、随机对照试验和队列研究进行了系统性回顾，以提供关于 ASDeg 和 ASDis 的循证信息。
一项荟萃分析显示，腰椎和颈椎融合术后 ASDeg 的总体发生率分别为 26.6%和 32.8%。约 1/4-1/3 的 ASDeg 进展为 ASDis。颈椎融合术后的危险因素包括年龄较小、存在椎间盘退变、融合节段较短、T1 斜率较高、相邻软组织破坏以及临近椎间盘置板。腰椎融合术后 ASDeg 和 ASDis 的危险因素包括年龄、遗传因素、高体重指数、临近节段退变、融合相邻节段的椎板切除术、融合节段过度牵开、腰椎前凸不足、多节段固定、浮动融合、L5-S 椎间盘冠状面楔变、骨盆倾斜和骨质疏松症。与传统融合手术相比，保留运动的手术似乎在腰椎和颈椎都有较低的 ASDeg 和 ASDis 风险。
现有文献指出了与 ASDeg 和 ASDis 相关的变量。高证据水平的研究应提供更多相关数据，以指导避免 ASDeg 和 ASDis 的策略。
