Li Yong, Cheng Peiyan, Zhang Xiaolei, Cheng Cai
Department of Spinal Surgery, Cangzhou Central Hospital, Cangzhou, 061000, People's Republic of China.
Orthop Res Rev. 2025 Jul 28;17:361-371. doi: 10.2147/ORR.S533548. eCollection 2025.
Adjacent segment degeneration (ASD) is a common complication after anterior cervical decompression and fusion (ACDF). The spino cranial angle (SCA), a novel sagittal parameter reflecting head-to-cervical alignment, may be associated with ASD, yet its predictive value remains unclear.
A total of 98 patients who underwent single-level ACDF with at least 24 months of follow-up were retrospectively analyzed. Radiographic evaluations were conducted preoperatively and at 3, 6, 12, and 24 months postoperatively. Patients were classified into ASD and non-ASD groups based on established radiographic criteria. Pre- and postoperative cervical sagittal parameters, including SCA, T1 slope (T1s), sagittal segmental alignment (SSA), sagittal alignment of the cervical spine (SACS), and C2-C7 sagittal vertical axis (cSVA) were measured. Clinical outcomes were assessed using the Japanese Orthopedic Association (JOA) score, Neck Disability Index (NDI), and Visual Analog Scale (VAS) scores. Multivariate logistic regression and Receiver operating characteristic (ROC) curve analysis were performed to identify independent predictors of ASD.
ASD occurred in 36 patients (36.7%). Preoperative SCA was significantly larger in the ASD group compared to the non-ASD group (86.7° ± 7.4° vs 80.5° ± 6.9°, p < 0.001), while T1s and SSA were significantly smaller (p = 0.015 and p = 0.001, respectively). Multivariate analysis identified preoperative SCA as the only independent risk factor for ASD (OR = 1.279, 95% CI: 1.010-1.619, p = 0.041). Patients with SCA > 84.2° showed a significantly higher incidence of ASD (55.8% vs 21.4%, p < 0.001). ROC analysis demonstrated that SCA had good predictive value for ASD development. No significant differences were observed in JOA, NDI, or VAS scores between the two groups at final follow-up.
Preoperative SCA is a significant predictor of ASD, and may be considered in preoperative risk assessment.
相邻节段退变（ASD）是颈椎前路减压融合术（ACDF）后常见的并发症。脊柱颅角（SCA）是一种反映头部与颈椎对线关系的新型矢状面参数，可能与ASD有关，但其预测价值尚不清楚。
回顾性分析98例行单节段ACDF且随访至少24个月的患者。术前及术后3、6、12和24个月进行影像学评估。根据既定的影像学标准将患者分为ASD组和非ASD组。测量术前及术后颈椎矢状面参数，包括SCA、T1斜率（T1s）、矢状节段对线（SSA）、颈椎矢状对线（SACS）和C2-C7矢状垂直轴（cSVA）。使用日本骨科协会（JOA）评分、颈部功能障碍指数（NDI）和视觉模拟量表（VAS）评分评估临床结局。进行多因素逻辑回归和受试者工作特征（ROC）曲线分析以确定ASD的独立预测因素。
36例患者（36.7%）发生ASD。与非ASD组相比，ASD组术前SCA显著更大（86.7°±7.4° vs 80.5°±6.9°，p<0.001），而T1s和SSA显著更小（分别为p = 0.015和p = 0.001）。多因素分析确定术前SCA是ASD的唯一独立危险因素（OR = 1.279，95%CI：1.010-1.619，p = 0.041）。SCA>84.2°的患者ASD发生率显著更高（55.8% vs 21.4%，p<0.001）。ROC分析表明SCA对ASD的发生具有良好的预测价值。末次随访时两组间JOA、NDI或VAS评分无显著差异。
术前SCA是ASD的重要预测指标，可在术前风险评估中予以考虑。
