Department of Orthopedics, The First Affiliated Hospital of Soochow University, 899, Pinghai Road, Suzhou, 215006, China.
Orthopedic Institute, Soochow University, Suzhou, 215006, China.
BMC Musculoskelet Disord. 2019 Sep 14;20(1):430. doi: 10.1186/s12891-019-2800-0.
ASD is a relatively common degenerative alteration after cervical surgery which occurs above or below the fused segment. In addition, some patients may need reoperation to treat severe ASD after the primary surgery. It was considered that sagittal balance is correlated with postoperative clinical outcomes; however, few studies have reported the influence of sagittal balance on ASD. The present study is designed to investigate whether sagittal balance impacts the pathology of adjacent segment disease (ASD) in patients who undergo anterior cervical surgery for degenerative cervical disease.
Databases including Pubmed, Embase, Cochrane library, and Web of Science were used to search for literature published before June 2018. Review Manager 5.3 was used to perform the statistical analysis. Sagittal balance parameters before and after surgery were compared between patients with and without ASD. Weighted mean difference (WMD) was summarized for continuous data and P < 0.05 was set for the level of significance.
A total of 221 patients with ASD and 680 patients without ASD from seven articles were studied in this meta-analysis. There were no significant differences in most sagittal balance parameters between the two groups, except for postoperative cervical lordosis (CL) (WMD -3.30, CI -5.91, - 0.69, P = 0.01).
Some sagittal balance parameters may be associated with the development of ASD after anterior cervical surgery. Sufficient restoration of CL may decrease the incidence of ASD. The results in present study needed to be expanded carefully and further high-quality studies are warranted to investigate the impact of sagittal balance on ASD.
颈椎手术后，在融合节段上方或下方出现 ASD 是一种较为常见的退行性改变。此外，一些患者在初次手术后可能需要再次手术来治疗严重的 ASD。人们认为矢状位平衡与术后临床结果相关；然而，很少有研究报道矢状位平衡对 ASD 的影响。本研究旨在探讨颈椎退行性疾病行前路颈椎手术后矢状位平衡是否会影响邻近节段疾病（ASD）的发生。
检索 Pubmed、Embase、Cochrane 图书馆和 Web of Science 等数据库，检索时间截止至 2018 年 6 月前发表的文献。使用 Review Manager 5.3 进行统计分析。比较 ASD 患者与非 ASD 患者手术前后矢状位平衡参数。连续性数据采用加权均数差（WMD）进行总结，P<0.05 为差异有统计学意义。
共纳入 7 篇文献的 221 例 ASD 患者和 680 例非 ASD 患者。除术后颈椎前凸（CL）（WMD-3.30，CI-5.91，-0.69，P=0.01）外，两组大多数矢状位平衡参数无显著差异。
一些矢状位平衡参数可能与前路颈椎手术后 ASD 的发生有关。充分恢复 CL 可能会降低 ASD 的发生率。本研究结果需要谨慎扩展，进一步需要高质量的研究来探讨矢状位平衡对 ASD 的影响。
