接受 ACDF 治疗的患者发生邻近节段疾病的临床相关危险因素：系统评价。
Clinical risk factors associated with the development of adjacent segment disease in patients undergoing ACDF: A systematic review.
机构信息
Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA.
Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA; Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan.
出版信息
Spine J. 2023 Jan;23(1):146-156. doi: 10.1016/j.spinee.2022.08.011. Epub 2022 Aug 27.
BACKGROUND CONTEXT
Cervical fusion for degenerative disorders carries a known risk of adjacent segment disease (ASD), a complication that often requires surgical intervention to relieve symptoms. Proposed risk factors for development of ASD include both clinical and radiographic patient characteristics. However, the true impact of these risk factors is less understood due to limitations in sample sizes and loss to follow-up in individual studies.
PURPOSE
To review and critically examine current literature on the clinical risk factors associated with development of ASD in the cervical spine following ACDF.
STUDY DESIGN
Systematic Review and Meta-Analysis.
METHODS
We systematically reviewed the literature in December 2019 according to the PRISMA guidelines. Methodological quality of included papers and quality of evidence were evaluated according to MINORS and GRADE framework. Meta-analysis was performed to compute the odds ratio(OR)with corresponding 95% confidence interval(CI)for dichotomous data, and mean difference(MD) with 95% CI for continuous variables.
RESULTS
6,850 records were obtained using database query. Title/abstract screening resulted in 19 articles for full review, from which 10 papers met the criteria for analysis. There were no significant differences in gender (OR 0.99, 95% CI 0.75-1.30), BMI (MD -0.09, 95% CI -0.46 to 0.29), smoking (OR 1.13, 95% CI 0.80-1.59), alcohol (OR 1.07, 95% CI 0.70-1.64), diabetes (OR 0.85, 95% CI 0.56-1.31), number of segments fused (OR 0.86, 95% CI 0.64-1.16), and preoperative JOA (MD -0.50, 95% CI -1.04 to 0.04). Age (MD 3.21, 95% CI 2.00-4.42), congenital/developmental stenosis (OR 1.94, 95% CI 1.06-3.56), preoperative NDI (MD 4.18, 95% CI 2.11 to 6.26), preoperative VAS (neck) (MD 0.54 95% CI 0.09-0.99), and preoperative VAS (arm) (MD 0.98, 95% CI 0.43-1.34) were found to be statistically significant risk factors.
CONCLUSION
Patients with congenital stenosis, advanced age, and high preoperative NDI are at increased risk of developing ASD.
背景背景
退行性疾病的颈椎融合术存在已知的邻近节段疾病（ASD）风险，这是一种经常需要手术干预以缓解症状的并发症。已提出的 ASD 发展的危险因素包括临床和影像学患者特征。然而，由于个别研究中样本量和随访丢失的限制，这些危险因素的真正影响仍不明确。
目的
综述和批判性评估与 ACDF 后颈椎 ASDF 相关的临床危险因素。
研究设计
系统评价和荟萃分析。
方法
我们根据 PRISMA 指南于 2019 年 12 月系统地检索了文献。根据 MINORS 和 GRADE 框架评估纳入论文的方法学质量和证据质量。对于二项数据，进行了荟萃分析以计算优势比（OR）及其相应的 95%置信区间（CI），对于连续变量，计算了均值差（MD）及其 95%CI。
结果
使用数据库查询获得了 6850 条记录。标题/摘要筛选后，有 19 篇文章进行了全面审查，其中有 10 篇文章符合分析标准。性别（OR 0.99，95%CI 0.75-1.30）、体重指数（MD-0.09，95%CI-0.46 至 0.29）、吸烟（OR 1.13，95%CI 0.80-1.59）、饮酒（OR 1.07，95%CI 0.70-1.64）、糖尿病（OR 0.85，95%CI 0.56-1.31）、融合节段数（OR 0.86，95%CI 0.64-1.16）和术前 JOA（MD-0.50，95%CI-1.04 至 0.04）无显著差异。年龄（MD3.21，95%CI2.00-4.42）、先天性/发育性狭窄（OR1.94，95%CI1.06-3.56）、术前 NDI（MD4.18，95%CI2.11-6.26）、术前 NDI（MD4.18，95%CI2.11-6.26）、术前 NDI（MD4.18，95%CI2.11-6.26）、术前 NDI（MD4.18，95%CI2.11-6.26）、术前 NDI（MD4.18，95%CI2.11-6.26）、术前 NDI（MD4.18，95%CI2.11-6.26）、术前 NDI（MD4.18，95%CI2.11-6.26）、术前 NDI（MD4.18，95%CI2.11-6.26）、术前 NDI（MD4.18，95%CI2.11-6.26）和术前 VAS（颈）（MD0.5495%CI0.09-0.99）和术前 VAS（臂）（MD0.98，95%CI0.43-1.34）被发现是统计学上显著的危险因素。
结论
先天性狭窄、年龄较大和术前 NDI 较高的患者发生 ASD 的风险增加。
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