BACKGROUND & AIMS:
BACKGROUND CONTEXT:A potential correlation between surgery for symptomatic adjacent segment degeneration (sASD) and the development of degenerative disease of the lumbar spine or osteoarthritis of the musculoskeletal joints remains to be determined.
PURPOSE:To assess the rate of sASD following anterior cervical discectomy and fusion (ACDF), the rate of lumbar discectomy (LD), and rate of surgery performed for osteoarthritis at the joints of the musculoskeletal in a long term follow-up.
STUDY DESIGN/SETTING:Cohort study OUTCOME MEASURES: Repeat procedure for sASD, microsurgical LD (MSD), and/or the musculoskeletal joints (shoulder, knee, hip).
PATIENT SAMPLE:Retrospectively, a total of 833 consecutive patients who underwent ACDF for degenerative disorders ≥20 years ago were identified. Charts were reviewed for preoperative neurological status, smoking status, physical labor, and repeat procedures. Missing data lead to exclusion from follow-up assessment.
METHODS:At final follow-up the need for pain medication, Neck disability index (NDI), and Odoms criteria were evaluated. An MRI was performed to assess the grade of degeneration of the cervical spine via the segmental degeneration index (SDI). Patients without (group 1) and with (group 2) repeat procedure for sASD were compared.
RESULTS:Collectively, 313 patients met inclusion criteria and 136 patients were evaluated. The mean follow-up was 26 years. Clinical success rate according to Odoms was 85.3%, mean NDI was 14.4%, the rate of regular intake of pain medication was 14.7%, the rate of repeated procedure for sASD was 10.3%. MSD was performed in 23.5%, surgery for osteoarthritis of the shoulder, the hip, and the knee were performed in 11.8%, 6.9%, and 27.7%, respectively. The rate of MSD (p=.018) was significantly higher in group 2 compared to group 1. Gender, smoking status, surgery of the musculoskeletal joints, and the grade of degeneration of the cranial and caudal adjacent segments were similar between group 1 and group 2.
CONCLUSION:The overall clinical success following ACDF was 85.3%. The rate of repeat procedure for sASD was 10.3% within 26 years. Patients with sASD had a significantly higher rate of MSD and poorer clinical outcome compared to patients without sASD.
背景与目标:
背景技术:有症状的邻近节段性变性(sASD)手术与腰椎退行性疾病或肌肉骨骼关节骨关节炎发展之间的潜在相关性尚待确定。
目的:评估长期随访中颈椎前路椎间盘切除术和融合术(ACDF)后sASD的发生率,腰椎间盘切除术(LD)的发生率以及肌肉骨骼关节骨关节炎的手术率。
研究设计/设置:队列研究结果指标:对sASD,显微外科手术LD(MSD)和/或肌肉骨骼关节(肩,膝,髋)重复操作。
病人样本:回顾性地,共鉴定出833例接受ACDF≥20年前的变性疾病的连续患者。复查图表以了解术前神经系统状况,吸烟状况,体力劳动和重复手术。缺少数据导致无法进行后续评估。
方法:在最后的随访中,评估了止痛药的需求,颈部残疾指数(NDI)和Odoms标准。进行了MRI,以通过节段性变性指数(SDI)评估颈椎变性的程度。比较了没有(第1组)和有(第2组)重复进行sASD的患者。
结果:共有313例患者符合入选标准,对136例患者进行了评估。平均随访时间为26年。根据Odoms的临床成功率为85.3%,平均NDI为14.4%,常规服用止痛药的比率为14.7%,重复进行sASD的比率为10.3%。 MSD手术率为23.5%,肩部,髋部和膝盖骨关节炎的手术率分别为11.8%,6.9%和27.7%。与第1组相比,第2组的MSD发生率(p = .018)明显更高。第1组和第2组之间的性别,吸烟状况,肌肉骨骼关节手术以及颅骨和尾端相邻节段的退化程度相似。第二组
结论:ACDF术后总的临床成功率为85.3%。 sASD的重复手术率在26年内为10.3%。与没有sASD的患者相比,患有sASD的患者的MSD发生率明显更高,而临床结局也较差。