Zong Rui, Liu Chuan-Yu, Jin Yuan-Zhi, Peng Zi-Han, He Jun-Bo, Wu Ting-Kui, Liu Hao, Yu An-Yun
Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, China.
Department of Anesthesiology, West China Hospital, West China School of Nursing, Sichuan University, Chengdu, Sichuan, 610041, China.
BMC Musculoskelet Disord. 2025 Jul 4;26(1):607. doi: 10.1186/s12891-025-08852-0.
Anterior cervical discectomy and fusion (ACDF) has been regarded as a standard procedure to treat Cervical degenerative disc disease (CDDD). Anterior bone loss (ABL), observed at the anterior vertebral body of the operative segment, usually considered to occur only after cervical disc replacement. However, some research showed ABL appears to be similarly prevalent following ACDF. Despite this recognition, the precise mechanisms and implications of ABL on surgical efficacy remain uncertain.
A total of 90 patients who underwent single-level ACDF using Zero-P with a minimum follow-up of at least one year were retrospectively reviewed. ABL was measured and classified into four grades according to Kieser's methods. According to that, the patients were grouped into none-mild ABL group and moderate-severe ABL group. Baseline data, clinical evaluation, and radiological parameters were recorded and compared.
Of the 90 patients, 57 (63.3%) developed ABL postoperatively. Among them, 16 cases (28.06%) were mild, 26 cases (45.64%) were moderate, and 15 cases (26.30%) were severe. Univariate Analysis (P = 0.008) and Logistic Regression (P = 0.006) revealed significant differences in body mass index (BMI) between the moderate-severe ABL group and none-mild group. Although a worse muscle condition was found in the former, it did not meet the significant criteria (P = 0.164). A more severe ABL did not affect either clinical outcomes or radiological parameters. However, this can result in a higher incidence of implant subsidence and may accelerate the degeneration of the adjacent caudal segment.
ABL should be considered a common phenomenon after ACDF and reflects the degree to which the changed biomechanical condition changes. BMI was an independent influencing factor for the occurrence of moderate-severe ABL. ABL does not affect clinical outcomes but is associated with implant subsidence and accelerated degeneration of the adjacent caudal disc.
颈椎前路椎间盘切除融合术（ACDF）一直被视为治疗颈椎退行性椎间盘疾病（CDDD）的标准术式。手术节段椎体前缘骨丢失（ABL）通常被认为仅在颈椎间盘置换术后出现。然而，一些研究表明，ACDF术后ABL的发生率似乎同样较高。尽管已有此认识，但ABL的确切机制及其对手术疗效的影响仍不明确。
回顾性分析90例行单节段Zero-P ACDF且至少随访1年的患者。采用Kieser法测量ABL并分为4级。据此，将患者分为无-轻度ABL组和中度-重度ABL组。记录并比较基线数据、临床评估和影像学参数。
90例患者中，57例（63.3%）术后发生ABL。其中，轻度16例（28.06%），中度26例（45.64%），重度15例（26.30%）。单因素分析（P = 0.008）和逻辑回归分析（P = 0.006）显示，中度-重度ABL组与无-轻度ABL组在体重指数（BMI）方面存在显著差异。尽管前者肌肉状况较差，但未达到显著标准（P = 0.164）。更严重的ABL既不影响临床结局，也不影响影像学参数。然而，这可能导致植入物下沉的发生率更高，并可能加速相邻尾段的退变。
ABL应被视为ACDF术后的常见现象，反映了生物力学条件改变的程度。BMI是中度-重度ABL发生的独立影响因素。ABL不影响临床结局，但与植入物下沉及相邻尾段椎间盘加速退变有关。
