Zhou Feifei, Li Shuyang, Zhao Yanbin, Zhang Yilong, Ju Kevin L, Zhang Fengshan, Pan Shengfa, Sun Yu
1Department of Orthopaedics, Peking University Third Hospital, Beijing, China; and.
2Texas Back Institute, Plano, Texas.
J Neurosurg Spine. 2020 Jul 17;33(5):674-679. doi: 10.3171/2020.4.SPINE191303. Print 2020 Nov 1.
The authors aimed to identify factors that may be useful for quantifying the amount of degenerative change in preoperative patients to identify ideal candidates for cervical disc replacement (CDR) in patients with a minimum of 10 years of follow-up data.
During the period from December 2003 to August 2008, 54 patients underwent CDR with a Bryan cervical disc prosthesis performed by the same group of surgeons, and all of the patients in this group with at least 10 years of follow-up data were enrolled in this retrospective analysis of cases. Postoperative bone formation was graded in radiographic images by using the McAfee classification for heterotopic ossification. Preoperative degeneration was evaluated in radiographs based on a quantitative scoring system. After univariate analysis, the authors performed multifactor logistic regression analysis to identify significant factors. To determine the cutoff points for the significant factors, a receiver operating characteristic (ROC) curve analysis was conducted.
Study patients had a mean age of 43.6 years and an average follow-up period of 120.3 months. The patients as a group had a 68.2% overall incidence of bone formation. Based on univariate analysis results, data for patient sex, disc height, and the presence of anterior osteophytes and endplate sclerosis were included in the multivariate analysis. According to the analysis results, the identified independent risk factors for postoperative bone formation included disc height, the presence of anterior osteophytes, and endplate sclerosis, and according to a quantitative scoring system for degeneration of the cervical spine based on these variables, the ROC curve indicated that the optimal cutoff scores for these risk factors were 0.5, 1.5, and 1.5, respectively.
Among the patients who were followed up for at least 10 years after CDR, the incidence of postoperative bone formation was relatively high. The study results indicate that the degree of degeneration in the target level before surgery has a positive correlation with the incidence of postoperative ossification. Rigorous indication criteria for postoperative ossification should be applied in patients for whom CDR may be a treatment option.
作者旨在确定可能有助于量化术前患者退变程度的因素，以便在有至少10年随访数据的患者中识别颈椎间盘置换（CDR）的理想候选者。
在2003年12月至2008年8月期间，54例患者接受了由同一组外科医生进行的Bryan颈椎间盘假体CDR手术，该组中所有有至少10年随访数据的患者均纳入本病例回顾性分析。通过使用McAfee异位骨化分类法对术后X线图像中的骨形成进行分级。基于定量评分系统在X线片中评估术前退变情况。单因素分析后，作者进行多因素逻辑回归分析以确定显著因素。为确定显著因素的截断点，进行了受试者工作特征（ROC）曲线分析。
研究患者的平均年龄为43.6岁，平均随访期为120.3个月。该组患者骨形成的总体发生率为68.2%。基于单因素分析结果，患者性别、椎间盘高度、前方骨赘和终板硬化情况的数据被纳入多因素分析。根据分析结果，确定的术后骨形成独立危险因素包括椎间盘高度、前方骨赘的存在和终板硬化，并且根据基于这些变量的颈椎退变定量评分系统，ROC曲线表明这些危险因素的最佳截断分数分别为0.5、1.5和1.5。
在CDR术后至少随访10年的患者中，术后骨形成的发生率相对较高。研究结果表明，手术前目标节段的退变程度与术后骨化的发生率呈正相关。对于可能选择CDR治疗的患者，应应用严格的术后骨化指征标准。
