Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China.
Spine (Phila Pa 1976). 2021 Feb 15;46(4):E257-E266. doi: 10.1097/BRS.0000000000003761.
A retrospective study.
The aim of this study was to investigate the ability of Global Alignment and Proportion (GAP) score to predict the occurrence of adjacent segment degeneration (ASD) after fusion surgery for lumbar degenerative diseases.
The recently developed GAP score was applied to predict postoperative complications for adult spinal deformity, as well as to facilitate future outcome-based research on optimal treatment for various spinal conditions. However, it remains unclear whether reconstruction of alignment according to GAP score can reduce the ASD rates.
This study retrospectively reviewed 126 consecutive patients who had undergone lumbar fusion and had been followed over 2 years. Pre- and postoperative radiographs and MRI were analyzed for ASD. GAP scores were calculated based on the early postoperative spinopelvic parameters. Cochran-Armitage test of trend was performed to investigate the association between GAP score and the occurrence of ASD. Receiver-operating characteristic curves were used to analyze the predictive accuracy of the GAP score for ASD.
Radiographical ASD (R-ASD) and symptomatic ASD (S-ASD) were diagnosed in 44 (34.9%) patients and in 13 (10.3%) patients, respectively. The patients with a proportioned spinopelvic state according to the GAP score had significantly lower rates of ASD (R-ASD and S-ASD) or S-ASD than those with a moderately or severely disproportioned spinopelvic state. The area under curve for the GAP score predicting ASD and S-ASD was 0.691 (95% confidence interval [CI]: 0.596∼0.785, P < 0.01) and 0.865 (95% CI: 0.771∼0.958, P < 0.01), respectively.
Our study revealed a significant association between postoperative GAP score and occurrence of ASD after lumbar fusion surgery. Setting surgical goals according to the GAP score may help reduce the occurrence of ASD, especially for S-ASD.Level of Evidence: 4.
回顾性研究。
本研究旨在探讨全局对准和比例（GAP）评分能否预测腰椎退行性疾病融合手术后邻近节段退变（ASD）的发生。
最近开发的 GAP 评分已应用于预测成人脊柱畸形的术后并发症，并有助于未来基于结果的研究，以确定各种脊柱疾病的最佳治疗方法。然而，根据 GAP 评分重建对线是否可以降低 ASD 发生率尚不清楚。
本研究回顾性分析了 126 例连续接受腰椎融合术并随访超过 2 年的患者。分析了术前和术后 X 线片和 MRI 以确定 ASD。根据术后早期脊柱骨盆参数计算 GAP 评分。采用 Cochran-Armitage 趋势检验分析 GAP 评分与 ASD 发生之间的相关性。采用受试者工作特征曲线分析 GAP 评分对 ASD 的预测准确性。
44 例（34.9%）患者出现影像学 ASD（R-ASD），13 例（10.3%）患者出现症状性 ASD（S-ASD）。根据 GAP 评分，脊柱骨盆状态比例适当的患者 ASD（R-ASD 和 S-ASD）或 S-ASD 的发生率明显低于脊柱骨盆状态中度或重度失调的患者。GAP 评分预测 ASD 和 S-ASD 的曲线下面积分别为 0.691（95%置信区间[CI]：0.596∼0.785，P＜0.01）和 0.865（95% CI：0.771∼0.958，P＜0.01）。
本研究表明，腰椎融合术后 GAP 评分与 ASD 的发生有显著相关性。根据 GAP 评分设定手术目标可能有助于降低 ASD 的发生，尤其是 S-ASD。
4 级
