What is the Early Fate of the Adjacent Segmental Angles Following a Single-level Anterior Cervical Discectomy Fusion for Degenerative Pathology?

IF 1.7 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Spine Surgery Pub Date : 2025-07-11 DOI:10.1097/BSD.0000000000001836

Rakesh Kumar, Landon Basner, Thomas Hanks, Aiyush Bansal, Murad Alostaz, Alice Sohn, Patricia Lipson, Jean-Christophe A Leveque, Venu M Nemani, Philip K Louie

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引用次数: 0

Abstract

Study design: Retrospective case series study.

Objective: This study aims to investigate adjacent segmental angle changes postsingle-level anterior cervical discectomy and fusion (ACDF).

Summary of background data: Anterior cervical fusion's impact on adjacent levels and global cervical alignment remains insufficiently understood, with potential implications for surgical planning and radiographic outcomes.

Methods: A single-center retrospective analysis of consecutive patients undergoing single-level ACDF for degenerative pathology was conducted. Preoperative and 12-month postoperative lateral cervical plain radiographs were evaluated. Measured parameters included pre and postoperative C2-C7 lordosis, segmental lordosis of the fusion and adjacent levels, T1-slope, occipito-C2 angle (O-C2), and C2-C7 sagittal vertical axis. Patients were stratified by operative level. Univariate and multivariate analyses were performed.

Results: Seventy patients were included (18 C4-C5, 35 C5-C6, and 17 C6-C7 operative levels). No significant changes were observed in any of the measured parameters at the C4-C5 level. Likewise, at the C5-C6 level, there were no clinically significant changes in any parameters. At the C6-C7 level, significant alterations in segmental angles were observed. At this level, the ACDF procedure led to an overall loss of lordosis of 3.48 degrees with an associated lordotic change in the supra- and infra-adjacent levels, which preferentially favored change at the supra-adjacent level (4.83 degrees of lordosis response) compared with the infra-adjacent level (3.52 degrees of lordotic response).

Conclusions: This study suggests that preoperative cervical lordosis may influence adjacent segmental angles after single-level ACDF procedures, offering crucial insights for future research and preoperative planning. Understanding these dynamics is crucial for preserving cervical lordosis and managing adjacent segment disease.

Level of evidence: Level IV.

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单节段颈椎前路椎间盘切除术融合治疗退行性病理后相邻节段角的早期命运如何？

研究设计：回顾性病例系列研究。目的：探讨单节段颈前路椎间盘切除术融合术后临近节段角度的变化。背景资料总结：颈椎前路融合对相邻节段和整体颈椎对位的影响尚不清楚，这对手术计划和影像学结果有潜在的影响。方法：对因退行性病理而接受单级别ACDF的连续患者进行单中心回顾性分析。术前和术后12个月颈椎侧位平片评估。测量参数包括术前和术后C2-C7前凸、融合节段性前凸及相邻节段性前凸、t1斜率、枕c2角（O-C2）和C2-C7矢状垂直轴。患者按手术水平分层。进行单因素和多因素分析。结果：纳入70例患者（18例C4-C5, 35例C5-C6, 17例C6-C7手术水平）。在C4-C5水平的任何测量参数均未观察到显著变化。同样，在C5-C6水平，任何参数均无临床显著变化。在C6-C7水平，观察到节段角度的显著改变。在这个水平，ACDF手术导致3.48度的脊柱前凸整体消失，并伴有上邻段和下邻段的脊柱前凸变化，与下邻段（3.52度脊柱前凸反应）相比，上邻段（4.83度脊柱前凸反应）的脊柱前凸变化更明显。结论：本研究提示术前颈椎前凸可能影响单节段ACDF手术后邻近节段的角度，为未来的研究和术前规划提供了重要的见解。了解这些动态对于保持颈椎前凸和处理邻近节段疾病至关重要。证据等级：四级。

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来源期刊

Clinical Spine Surgery Medicine-Surgery

CiteScore

3.00

自引率

5.30%

发文量

236

期刊介绍： Clinical Spine Surgery is the ideal journal for the busy practicing spine surgeon or trainee, as it is the only journal necessary to keep up to date with new clinical research and surgical techniques. Readers get to watch leaders in the field debate controversial topics in a new controversies section, and gain access to evidence-based reviews of important pathologies in the systematic reviews section. The journal features a surgical technique complete with a video, and a tips and tricks section that allows surgeons to review the important steps prior to a complex procedure. Clinical Spine Surgery provides readers with primary research studies, specifically level 1, 2 and 3 studies, ensuring that articles that may actually change a surgeon’s practice will be read and published. Each issue includes a brief article that will help a surgeon better understand the business of healthcare, as well as an article that will help a surgeon understand how to interpret increasingly complex research methodology. Clinical Spine Surgery is your single source for up-to-date, evidence-based recommendations for spine care.