Surgery-related Factors Do Not Affect Short-term Adjacent Segment Kinematics After Anterior Cervical Arthrodesis.
Surgery-related Factors Do Not Affect Short-term Adjacent Segment Kinematics After Anterior Cervical Arthrodesis.
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DOI：
10.1097/brs.0000000000004080
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发表时间：
2021-12-01
期刊：
影响因子：
3
通讯作者：
Anderst WJ
中科院分区：
文献类型：
--
作者：
Chen SR;LeVasseur CM;Pitcairn S;Kanter AS;Okonkwo DO;Shaw JD;Donaldson WF;Lee JY;Anderst WJ
前瞻性队列研究旨在通过双平面X线摄影确定影响颈椎前路椎间盘切除融合术（ACDF）后相邻节段运动学的手术因素。以前的研究调查了手术因素对脊柱运动学的影响，作为相邻节段疾病（ASD）的潜在病因。这些研究使用静态屈伸X线片评价活动度。然而，已知静态射线照片的测量是不可靠的。此外，这些研究无法评价ACDF对相邻节段轴向旋转的影响。术前和ACDF后1年，患者在动态双平面X线摄影系统中以每秒30张图像的速度拍摄了连续的颈椎屈曲/伸展和轴向旋转运动。使用先前确认的跟踪过程，将受试者特定CT扫描生成的数字重建X线片与双平面X线片进行匹配。动态运动学，术后节段性脊柱后凸，椎间盘牵引计算从这个跟踪过程。在术后X线片上测量板间距离。从病历中收集移植物类型。进行多变量线性回归，以确定与术后1年相邻节段运动学变化相关的手术因素。还进行了二次分析，以比较每个手术因素与先前定义的阈值之间的相邻节段运动学，这些阈值被认为与相邻节段退变相关。59名患者完成了术前和术后测试。任何手术因素与相邻节段屈曲/伸展或轴向旋转活动范围的变化之间均无相关性（所有p>0.09）。二次分析也没有发现相邻节段运动学和手术因素之间的差异（所有p>0.07）。ACDF治疗颈椎病后，与手术技术相关的因素与相邻节段运动学的短期变化无关，这些变化反映了假设导致ASD发展的过度活动。
Prospective cohort study To identify surgical factors that affect adjacent segment kinematics after anterior cervical discectomy and fusion (ACDF) as measured by biplane radiography. Previous studies investigated the effect of surgical factors on spine kinematics as a potential etiology for adjacent segment disease (ASD). Those studies used static flexion-extension radiographs to evaluate range of motion. However, measurements from static radiographs are known to be unreliable. Furthermore, those studies were unable to evaluate the effect of ACDF on adjacent segment axial rotation. Patients had continuous cervical spine flexion/extension and axial rotation movements captured at 30 images per second in a dynamic biplane radiography system preoperatively and 1 year after ACDF. Digitally reconstructed radiographs generated from subject-specific CT scans were matched to biplane radiographs using a previously validated tracking process. Dynamic kinematics, postoperative segmental kyphosis, and disc distraction were calculated from this tracking process. Plate-to-disc distance was measured on postoperative radiographs. Graft type was collected from the medical record. Multivariate linear regression was performed to identify surgical factors associated with 1-year post-surgery changes in adjacent segment kinematics. A secondary analysis was also performed to compare adjacent segment kinematics between each of the surgical factors and previously defined thresholds believed to be associated with adjacent segment degeneration. Fifty-nine patients completed preoperative and postoperative testing. No association was found between any of the surgical factors and change in adjacent segment flexion/extension or axial rotation range of motion (all p>0.09). The secondary analysis also did not identify differences between adjacent segment kinematics and surgical factors (all p>0.07). Following ACDF for cervical spondylosis, factors related to surgical technique were not associated with short-term changes in adjacent segment kinematics that reflect the hypermobility hypothesized to lead to the development of ASD.