Kong Lingde, Sun Changjun, Kou Ningzhao, Bai Jiangbo, Zhang Jingtao, Lu Jian, Tian Dehu
Department of Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang.
Department of Emergency, The Second Hospital of Tangshan City, Tangshan.
Medicine (Baltimore). 2018 Nov;97(48):e13480. doi: 10.1097/MD.0000000000013480.
Few clinical studies investigate risk factors associated with clinical adjacent segment pathology (CASP) following multi-level cervical fusion surgery. The aim is to record the incidence of postoperative CASP in patients after at least 2 years' follow-up and to identify possible risk factors that may be associated with the CASP after multi-level cervical surgery.We retrospectively reviewed patients who underwent multi-level cervical surgery in our hospital from January 2004 to February 2016. All patients underwent more than 2 years' follow-up. The diagnosis of CASP is according to clinical symptoms as well as image findings. Potential risk factors were collected from demographic data and radiographic images.A total of 301 patients after multi-level cervical surgery were analyzed. During follow-up, 28 patients (9.3%) were diagnosed as having CASP. Among these patients, 7 showed symptoms of CASP within 3 years after surgery, 6 showed symptoms between 3 and 5 years, 14 showed symptoms between 5 and 10 years, and the last one showed symptoms more than 10 years later. In the multivariate analysis, degeneration of adjacent segment (OR, 1.592; 95% CI, 1.113-2.277), decreased Cobb angle in fused vertebrae (OR, 2.113; 95% CI, 1.338-3.334) and decreased Cobb angle in cervical spine (OR, 1.896; 95% CI, 1.246-2.886) were correlated with the incidence of CASP during follow-up.The incidence of CASP following multi-level cervical surgery was 9.3% with a mean of about 70 months' follow-up. Patients with preoperative degeneration of adjacent segment and postoperative imbalance of sagittal alignment have a higher risk of developing CASP after multi-level cervical surgery.
很少有临床研究调查多节段颈椎融合手术后与临床相邻节段病变（CASP）相关的危险因素。目的是记录至少随访2年后患者术后CASP的发生率，并确定多节段颈椎手术后可能与CASP相关的危险因素。我们回顾性分析了2004年1月至2016年2月在我院接受多节段颈椎手术的患者。所有患者均接受了超过2年的随访。CASP的诊断依据临床症状以及影像学检查结果。从人口统计学数据和影像学图像中收集潜在危险因素。共分析了301例接受多节段颈椎手术的患者。随访期间，28例患者（9.3%）被诊断为患有CASP。在这些患者中，7例在术后3年内出现CASP症状，6例在3至5年之间出现症状，14例在5至10年之间出现症状，最后1例在10年以上出现症状。多因素分析显示，相邻节段退变（OR，1.592；95%CI，1.113 - 2.277）、融合椎体Cobb角减小（OR，2.113；95%CI，1.338 - 3.334）和颈椎Cobb角减小（OR，1.896；95%CI，1.246 - 2.886）与随访期间CASP的发生率相关。多节段颈椎手术后CASP的发生率为9.3%，平均随访时间约70个月。术前相邻节段退变且术后矢状位排列失衡的患者在多节段颈椎手术后发生CASP的风险更高。
