Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR.
Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR.
J Bone Joint Surg Am. 2021 Aug 4;103(15):1438-1450. doi: 10.2106/JBJS.20.00408.
Although multiple studies have investigated risk factors for symptomatic adjacent segment disease (ASD) after lumbar fusion, their findings were diverse and inconsistent. This review aimed to summarize risk factors for ASD in order to guide the management of ASD and future research.
Six electronic databases were systematically searched from inception to December 2019. Two reviewers independently screened titles, abstracts, and full-text articles to identify studies investigating risk factors for ASD after lumbar fusion in humans. The methodological quality of the included studies and the strength of evidence regarding risk factors were evaluated.
Sixteen studies involving 3,553 patients were included. Meta-analyses revealed that high body mass index, facet joint violation, anterior shift of the preoperative and postoperative lumbosacral sagittal plumb line, decreased preoperative and postoperative lumbar lordosis, preoperative adjacent disc degeneration, decreased preoperative adjacent disc height, increased postoperative lumbopelvic mismatch, postoperative pelvic incidence, and postoperative pelvic tilt were significantly related to ASD.
This meta-analysis addressed the limitations of prior reviews and summarized evidence with regard to risk factors for ASD following lumbar fusion. Future prospective studies should investigate whether modification of these risk factors can reduce the ASD development.
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
尽管多项研究已经调查了腰椎融合术后症状性邻近节段疾病（ASD）的危险因素，但他们的发现存在差异且不一致。本综述旨在总结 ASD 的危险因素，以指导 ASD 的管理和未来的研究。
从创建到 2019 年 12 月，我们系统性地在六个电子数据库中进行检索。两名评审员独立筛选标题、摘要和全文文章，以确定人类腰椎融合术后 ASD 危险因素的研究。评估了纳入研究的方法学质量和危险因素的证据强度。
纳入了 16 项涉及 3553 名患者的研究。荟萃分析显示，高体重指数、关节突关节侵犯、术前和术后腰骶脊柱矢状铅垂线的前移、术前和术后腰椎前凸减少、术前邻近椎间盘退变、术前邻近椎间盘高度降低、术后腰骨盆不匹配增加、术后骨盆入射角和术后骨盆倾斜与 ASD 显著相关。
本荟萃分析解决了先前综述的局限性，并总结了腰椎融合术后 ASD 危险因素的证据。未来的前瞻性研究应探讨是否可以通过改变这些危险因素来降低 ASD 的发生。
预后 IV 级。有关证据水平的完整描述，请参阅作者指南。
