目的:本研究旨在评估手术入路和其他因素对青少年特发性脊柱侧凸(AIS)脊柱融合术后相邻节段变性(ASD)发生率的影响。
方法:我们从四个电子数据库开始到2023年3月30日,对它们进行了全面搜索。两名独立审稿人筛选了标题,摘要,和全文,并评估了研究的方法学质量。使用随机效应模型来计算ASD的发生率。
结果:我们的分析包括14项研究,涉及651名个体。ASD的总发生率为47%(95CI:0.37,0.56)。亚组分析显示,ASD的患病率随术后时间增加(53%(95CI:0.31,0.75)对48%(95CI:0.36,0.60)对39%(95CI:0.22,0.56))。对于熔合段的数量,超过10个区组的患病率较高(49%(95CI:0.38,0.60)vs44%(95CI:0.21,0.69)).就地区而言,东亚的患病率最高,其次是西方和西亚(52%(95CI:0.41,0.62)对43%(95CI:0.20,0.68)对37%(95CI:0.17,0.59))。然而,手术方法,男性比例,最低器械椎骨(LIV)的位置在组间没有显着差异。漏斗图和Egger检验没有发现任何显著的发表偏倚(Egger检验:t=1.62,p值=.1274)。
结论:这项荟萃分析发现,近一半的脊柱融合术后的AIS患者经历了ASD。长期随访,定期筛查,及时的干预对于降低ASD的患病率至关重要。
OBJECTIVE: This study aims to assess the impact of surgical approaches and other factors on the incidence of Adjacent Segment
Degeneration (ASD) following Spinal Fusion for Adolescent Idiopathic Scoliosis (AIS).
METHODS: We conducted a comprehensive search of four electronic databases from their inception until March 30, 2023. Two independent reviewers screened titles, abstracts, and full texts and evaluated the methodological quality of the studies. A random-effects model was used to calculate the incidence of ASD.
RESULTS: Our analysis included 14 studies involving 651 individuals. The overall incidence of ASD was 47% (95%CI: 0.37, 0.56). Subgroup analyses revealed that the prevalence of ASD increased with postoperative time (53% (95%CI: 0.31, 0.75) versus 48% (95%CI: 0.36, 0.60) versus 39% (95%CI: 0.22, 0.56)). For the number of fused segments, a group with more than 10 segments had a higher prevalence (49% (95%CI: 0.38, 0.60) versus 44% (95%CI: 0.21, 0.69)). In terms of regions, East Asia had the highest prevalence, followed by Occident and West Asia (52% (95%CI: 0.41, 0.62) versus 43% (95%CI: 0.20, 0.68) versus 37% (95%CI: 0.17, 0.59)). However, the surgical approach, male ratio, and the position of the lowest instrumented vertebra (LIV) did not show significant differences between groups. Funnel plots and Egger\'s test did not reveal any significant publication bias (Egger\'s test: t = 1.62, p-value = .1274).
CONCLUSIONS: This meta-analysis found that nearly half of AIS patients following spinal fusion surgery experienced ASD. Long-term follow-up, regular screening, and timely interventions are essential to reduce the prevalence of ASD.