Mesregah Mohamed Kamal, Baker Melissa, Yoon Camilla, Meisel Hans-Joerg, Hsieh Patrick, Wang Jeffrey C, Yoon S Tim, Buser Zorica
Department of Orthopaedic Surgery, Menoufia University Faculty of Medicine, Shebin El-Kom, Menoufia, Egypt.
Gerling Institute, New York, NY, USA.
Global Spine J. 2024 Sep;14(7):2183-2200. doi: 10.1177/21925682241237500. Epub 2024 Mar 12.
Systematic review and meta-analysis.
To assess the radiographic risk factors for adjacent segment disease (ASD) following anterior cervical discectomy and fusion (ACDF) for degenerative cervical spine pathologies.
PubMed, Embase and the Cochrane Library databases were searched up to December 2023. The primary inclusion criteria were degenerative spinal conditions treated with ACDF, comparing radiological parameters in patients with and without postoperative ASD. The radiographic parameters included intervertebral disc height, cervical sagittal alignment, sagittal segmental alignment, range of motion, segmental height, T1 slope, sagittal vertical axis (SVA), thoracic inlet angle (TIA), and plate to disc distance (PPD). Risk of bias was assessed for all studies. The Cochrane Review Manager was utilized to perform the meta-analysis.
From 7044 articles, 13 retrospective studies were included in the final analysis. Three studies had "not serious" bias and the other 10 studies had serious or very serious bias. The total number of patients in the included studies was 1799 patients. Five studies included single-level ACDF, 2 studies included multi-level ACDF, and 6 studies included single or multi-level ACDF. On meta-analysis, the significant risk factors associated with ASD development were reduced postoperative cervical lordosis (mean difference [MD] = 3.35°, = .002), reduced last-follow-up cervical lordosis (MD = -3.02°, = .0003), increased preoperative to postoperative cervical sagittal alignment change (MD = -3.68°, = .03), and the presence of developmental cervical canal stenosis (Odds ratio [OR] = 4.17, < .001).
Decreased postoperative cervical lordosis, greater change in cervical sagittal alignment and developmental cervical canal stenosis were associated with an increased risk of ASD following ACDF.
系统评价与荟萃分析。
评估退行性颈椎疾病行前路颈椎间盘切除融合术（ACDF）后相邻节段疾病（ASD）的影像学危险因素。
检索截至2023年12月的PubMed、Embase和Cochrane图书馆数据库。主要纳入标准为接受ACDF治疗的退行性脊柱疾病，比较术后发生ASD和未发生ASD患者的影像学参数。影像学参数包括椎间盘高度、颈椎矢状位对线、矢状节段对线、活动范围、节段高度、T1斜率、矢状垂直轴（SVA）、胸廓入口角（TIA）以及钢板至椎间盘距离（PPD）。对所有研究进行偏倚风险评估。使用Cochrane系统评价软件进行荟萃分析。
从7044篇文章中，最终纳入13项回顾性研究。3项研究存在“不严重”偏倚，其他10项研究存在严重或非常严重的偏倚。纳入研究的患者总数为1799例。5项研究纳入单节段ACDF，2项研究纳入多节段ACDF，6项研究纳入单节段或多节段ACDF。荟萃分析显示，与ASD发生相关的显著危险因素包括术后颈椎前凸减少（平均差[MD]=3.35°，P = 0.002）、末次随访时颈椎前凸减少（MD = -3.02°，P = 0.0003）、术前至术后颈椎矢状位对线变化增加（MD = -3.68°，P = 0.03）以及存在发育性颈椎管狭窄（比值比[OR]=4.17，P < 0.001）。
ACDF术后颈椎前凸减少、颈椎矢状位对线变化较大以及发育性颈椎管狭窄与ASD风险增加相关。
