Salzmann Stephan N, Okano Ichiro, Miller Courtney Ortiz, Chiapparelli Erika, Reisener Marie-Jacqueline, Amini Dominik Adl, Winter Fabian, Shue Jennifer, Carrino John A, Sama Andrew A, Cammisa Frank P, Girardi Federico P, Hughes Alexander P
Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA.
Department of Orthopaedic Surgery and Traumatology, Charité University Hospital Berlin Chariteplatz 1, Berlin, Germany.
J Orthop Res. 2022 Mar;40(3):654-660. doi: 10.1002/jor.25069. Epub 2021 Jun 2.
The objective of this study is to determine the bone mineral density (BMD) changes in adjacent vertebra following anterior cervical discectomy and fusion (ACDF). Consecutive patients undergoing ACDF with available preoperative and postoperative computed tomography (CT) imaging were included. Quantitative CT measurements of screw-free cervical and first thoracic vertebra were performed. Comparisons between pre- and postoperative BMD in the vertebrae one or two levels above the upper instrumented vertebra (UIV + 1, UIV + 2) and one level below the lowest instrumented vertebra (LIV + 1) were assessed. Seventy-two patients (men, 66.7%) met the inclusion criteria. The patient population was 91.7% Caucasian with a mean age of 55.0 years. The mean interval (±SD) between surgery and secondary CT was 157 ± 23 days. Preoperative BMD (±SD) in UIV + 1 was 300.6 ± 66.2 mg/cm . There was a significant BMD loss of 1.5% at UIV + 1 after surgery, resulting in a postoperative BMD of 296.2 ± 64.8 mg/cm (p = .029). At UIV + 2 and LIV + 1, no significant differences between pre- and postoperative BMD (304.7 ± 75.7 mg/cm vs. 299.8 ± 74.3 mg/cm , 197.3 ± 50.4 mg/cm vs. 200.8 ± 48.7 mg/cm , p = .113 and p = .078, respectively) were observed. Clinical significance Our results demonstrate a small BMD decrease of 1.5% at UIV + 1. This suggests that the effect of ACDF surgery on the adjacent levels might be smaller compared to the previously described lumbar BMD loss of 10%-20% following posterior lumbar fusion procedures.
本研究的目的是确定颈椎前路椎间盘切除融合术（ACDF）后相邻椎体的骨密度（BMD）变化。纳入连续接受ACDF且有术前和术后计算机断层扫描（CT）影像的患者。对无螺钉的颈椎和第一胸椎进行定量CT测量。评估在上端固定椎体（UIV + 1、UIV + 2）上方一或两个椎体水平以及最低固定椎体（LIV + 1）下方一个椎体水平的术前和术后BMD之间的差异。72例患者（男性占66.7%）符合纳入标准。患者群体中91.7%为白种人，平均年龄55.0岁。手术与二次CT之间的平均间隔（±标准差）为157±23天。UIV + 1的术前BMD（±标准差）为300.6±66.2mg/cm。术后UIV + 1的BMD显著下降1.5%，术后BMD为296.2±64.8mg/cm（p = 0.029）。在UIV + 2和LIV + 1处，术前和术后BMD之间无显著差异（分别为304.7±75.7mg/cm与299.8±74.3mg/cm，197.3±50.4mg/cm与200.8±48.7mg/cm，p = 0.113和p = 0.078）。临床意义我们的结果表明UIV + 1处的BMD有1.5%的小幅下降。这表明与先前描述的腰椎后路融合术后10%-20%的腰椎BMD损失相比，ACDF手术对相邻节段的影响可能较小。
