方法:系统评价和荟萃分析。
目的:评估颈椎前路椎间盘切除融合术(ACDF)后相邻节段疾病(ASD)的影像学危险因素。
方法:PubMed,截至2023年12月,搜索了Embase和Cochrane图书馆数据库。主要纳入标准是用ACDF治疗的退行性脊柱疾病,比较有和没有术后ASD的患者的放射学参数。影像学参数包括椎间盘高度,颈椎矢状面对齐,矢状节段对齐,运动范围,节段高度,T1斜率,矢状垂直轴(SVA),胸廓入口角(TIA),和板盘距离(PPD)。评估所有研究的偏倚风险。利用Cochrane审查管理器进行荟萃分析。
结果:来自7044篇文章,最终分析包括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名患者。五项研究包括单水平ACDF,2项研究包括多层次ACDF,6项研究包括单水平或多水平ACDF。在荟萃分析中,与ASD发展相关的重要危险因素是术后宫颈前凸度降低(平均差异[MD]=3.35°,P=.002),末次随访宫颈前凸度降低(MD=-3.02°,P=.0003),术前增加至术后颈椎矢状位改变(MD=-3.68°,P=.03),和发育性宫颈管狭窄的存在(赔率比[OR]=4.17,P<.001)。
结论:术后宫颈曲度降低,宫颈矢状面排列和发育性宫颈管狭窄的较大改变与ACDF后ASD风险增加相关.
METHODS: Systematic review and meta-analysis.
OBJECTIVE: To assess the radiographic risk factors for adjacent segment disease (ASD) following anterior cervical discectomy and fusion (ACDF) for degenerative cervical spine pathologies.
METHODS: 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.
RESULTS: 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°, P = .002), reduced last-follow-up cervical lordosis (MD = -3.02°, P = .0003), increased preoperative to postoperative cervical sagittal alignment change (MD = -3.68°, P = .03), and the presence of developmental cervical canal stenosis (Odds ratio [OR] = 4.17, P < .001).
CONCLUSIONS: 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.