Kumar Rakesh, Basner Landon, Hanks Thomas, Bansal Aiyush, Alostaz Murad, Sohn Alice, Lipson Patricia, Leveque Jean-Christophe A, Nemani Venu M, Louie Philip K
Department of Neurosurgery, Center for Neuroscience and Spine, Virginia Mason Medical Center.
School of Medicine, University of Washington, Seattle, WA.
Clin Spine Surg. 2025 Jul 11. doi: 10.1097/BSD.0000000000001836.
Retrospective case series study.
This study aims to investigate adjacent segmental angle changes postsingle-level anterior cervical discectomy and fusion (ACDF).
Anterior cervical fusion's impact on adjacent levels and global cervical alignment remains insufficiently understood, with potential implications for surgical planning and radiographic outcomes.
A single-center retrospective analysis of consecutive patients undergoing single-level ACDF for degenerative pathology was conducted. Preoperative and 12-month postoperative lateral cervical plain radiographs were evaluated. Measured parameters included pre and postoperative C2-C7 lordosis, segmental lordosis of the fusion and adjacent levels, T1-slope, occipito-C2 angle (O-C2), and C2-C7 sagittal vertical axis. Patients were stratified by operative level. Univariate and multivariate analyses were performed.
Seventy patients were included (18 C4-C5, 35 C5-C6, and 17 C6-C7 operative levels). No significant changes were observed in any of the measured parameters at the C4-C5 level. Likewise, at the C5-C6 level, there were no clinically significant changes in any parameters. At the C6-C7 level, significant alterations in segmental angles were observed. At this level, the ACDF procedure led to an overall loss of lordosis of 3.48 degrees with an associated lordotic change in the supra- and infra-adjacent levels, which preferentially favored change at the supra-adjacent level (4.83 degrees of lordosis response) compared with the infra-adjacent level (3.52 degrees of lordotic response).
This study suggests that preoperative cervical lordosis may influence adjacent segmental angles after single-level ACDF procedures, offering crucial insights for future research and preoperative planning. Understanding these dynamics is crucial for preserving cervical lordosis and managing adjacent segment disease.
Level IV.
回顾性病例系列研究。
本研究旨在调查单节段颈椎前路椎间盘切除融合术（ACDF）后相邻节段角度的变化。
颈椎前路融合术对相邻节段和颈椎整体排列的影响仍未得到充分了解，这对手术规划和影像学结果可能具有潜在影响。
对因退行性病变接受单节段ACDF的连续患者进行单中心回顾性分析。评估术前和术后12个月的颈椎侧位X线平片。测量参数包括术前和术后C2-C7前凸、融合节段及相邻节段的节段性前凸、T1斜率、枕骨-C2角（O-C2）和C2-C7矢状垂直轴。患者按手术节段分层。进行单因素和多因素分析。
纳入70例患者（手术节段为C4-C5的18例、C5-C6的35例和C6-C7的17例）。C4-C5节段的任何测量参数均未观察到显著变化。同样，在C5-C6节段，任何参数均无临床显著变化。在C6-C7节段，观察到节段角度有显著改变。在此节段，ACDF手术导致整体前凸丢失3.48度，相邻上、下节段伴有相关的前凸变化，与相邻下节段（前凸反应3.52度）相比，相邻上节段的变化更明显（前凸反应4.83度）。
本研究表明，术前颈椎前凸可能影响单节段ACDF手术后的相邻节段角度，为未来研究和术前规划提供了重要见解。了解这些动态变化对于保持颈椎前凸和处理相邻节段疾病至关重要。
四级。
