BACKGROUND CONTEXT

Cervical fusion for degenerative disorders carries a known risk of adjacent segment disease (ASD), a complication that often requires surgical intervention to relieve symptoms. Proposed risk factors for development of ASD include both clinical and radiographic patient characteristics. However, the true impact of these risk factors is less understood due to limitations in sample sizes and loss to follow-up in individual studies.

PURPOSE

To review and critically examine current literature on the clinical risk factors associated with development of ASD in the cervical spine following ACDF.

STUDY DESIGN

Systematic Review and Meta-Analysis.

Methods

We systematically reviewed the literature in December 2019 according to the PRISMA guidelines. Methodological quality of included papers and quality of evidence were evaluated according to MINORS and GRADE framework. Meta-analysis was performed to compute the odds ratio(OR)with corresponding 95% confidence interval(CI)for dichotomous data, and mean difference(MD) with 95% CI for continuous variables.

RESULTS

6,850 records were obtained using database query. Title/abstract screening resulted in 19 articles for full review, from which 10 papers met the criteria for analysis. There were no significant differences in gender (OR 0.99, 95% CI 0.75–1.30), BMI (MD -0.09, 95% CI -0.46 to 0.29), smoking (OR 1.13, 95% CI 0.80–1.59), alcohol (OR 1.07, 95% CI 0.70–1.64), diabetes (OR 0.85, 95% CI 0.56–1.31), number of segments fused (OR 0.86, 95% CI 0.64–1.16), and preoperative JOA (MD -0.50, 95% CI -1.04 to 0.04). Age (MD 3.21, 95% CI 2.00–4.42), congenital/developmental stenosis (OR 1.94, 95% CI 1.06–3.56), preoperative NDI (MD 4.18, 95% CI 2.11 to 6.26), preoperative VAS (neck) (MD 0.54 95% CI 0.09–0.99), and preoperative VAS (arm) (MD 0.98, 95% CI 0.43–1.34) were found to be statistically significant risk factors.

CONCLUSION

Patients with congenital stenosis, advanced age, and high preoperative NDI are at increased risk of developing ASD.

中文翻译：

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与接受 ACDF 的患者发生相邻节段疾病相关的临床危险因素：一项系统评价

背景语境

退行性疾病的颈椎融合具有已知的相邻节段疾病 (ASD) 风险，这种并发症通常需要手术干预才能缓解症状。提出的 ASD 发展危险因素包括临床和影像学患者特征。然而，由于样本量的限制和个别研究的失访，这些风险因素的真正影响知之甚少。

目的

回顾和批判性地检查当前关于与 ACDF 后颈椎 ASD 发展相关的临床危险因素的文献。

学习规划

系统评价和荟萃分析。

方法

我们根据 PRISMA 指南系统地回顾了 2019 年 12 月的文献。根据 MINORS 和 GRADE 框架评估纳入论文的方法学质量和证据质量。进行荟萃分析以计算二分类数据的比值比（OR）和相应的 95% 置信区间（CI），以及连续变量的平均差（MD）和 95% CI。

结果

使用数据库查询获得了 6,850 条记录。标题/摘要筛选产生了 19 篇文章进行全面审查，其中 10 篇论文符合分析标准。性别（OR 0.99，95% CI 0.75–1.30）、BMI（MD -0.09，95% CI -0.46 至 0.29）、吸烟（OR 1.13，95% CI 0.80–1.59）、酒精（OR 1.07，95% CI 0.70–1.64），糖尿病（OR 0.85，95% CI 0.56–1.31），融合节段数（OR 0.86，95% CI 0.64–1.16）和术前 JOA（MD -0.50，95% CI -1.04 至 0.04）。年龄（MD 3.21，95% CI 2.00–4.42），先天性/发育性狭窄（OR 1.94，95% CI 1.06–3.56），术前 NDI（MD 4.18，95% CI 2.11 至 6.26），术前 VAS（颈部）（MD 0.54 95% CI 0.09–0.99) 和术前 VAS（手臂）（MD 0.98，95% CI 0.43–1.34）被发现是具有统计学意义的危险因素。

结论

患有先天性狭窄、高龄和高术前 NDI 的患者发生 ASD 的风险增加。