Impact of factors on treatment outcomes in cervical degenerative disc disease: a logistic regression analysis of anterior decompression and interbody fusion with BAK/C technique.
Liang Hao, Aobo Zhang, Fengming Zhao, Honglei Liu, Xiaoli Sun
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引用次数: 0
Abstract
Objectives: To identify predictive prognostic factors through logistic regression analysis in patients with cervical degenerative disc disease (CDDD) undergoing anterior cervical discectomy and fusion (ACDF) combined with the Bagby and Kuslich (BAK/C) interbody fusion technique.
Methods: This retrospective study included 80 patients treated with ACDF and BAK/C between January and December 2020, with a 3-year follow-up. Patients were stratified into a control group (favorable recovery, n = 52) and an observation group (poor recovery, n = 28) based on pain relief and neurological improvement. Radiological fusion rates and Japanese Orthopaedic Association (JOA) scores were evaluated. Multivariate logistic regression was performed to assess independent predictors of outcomes.
Results: The control group exhibited significant JOA score improvement at the final follow-up (14.49 ± 0.25 vs. preoperative 10.74 ± 1.16, P < 0.001), while the observation group showed limited recovery (12.19 ± 0.32 vs. preoperative 11.15 ± 1.45, P < 0.001). The overall fusion rate was significantly higher in the control group (92.3% vs. 64.3%, P = 0.002). Multivariate analysis identified age ≥55 years (observation group: 62.35 ± 5.41 vs. control: 51.47 ± 6.37, P < 0.001), reduced bone mineral density (T-score: -2.1 ± 0.8 vs. -1.3 ± 0.6, P < 0.001), postoperative complications (46.4% vs. 13.5%, P = 0.003), and baseline disease severity as independent risk factors for poor outcomes (P < 0.05). The observation group demonstrated significantly higher pseudoarthrosis rates (35.7% vs. 9.6%, P = 0.003).
Conclusion: Advanced age, low bone density, and postoperative complications critically compromise outcomes of ACDF with BAK/C fusion. Preoperative bone density optimization, judicious use of augmented multi-level fixation, and precision patient selection are pivotal for improving prognosis. These findings provide evidence-based insights for individualized clinical decision-making.
目的：通过logistic回归分析颈退变性椎间盘病（CDDD）行前路颈椎间盘切除术融合术（ACDF）联合Bagby and Kuslich （BAK/C）椎间融合技术的预后预测因素。方法：本回顾性研究包括80例在2020年1月至12月期间接受ACDF和BAK/C治疗的患者，随访3年。根据疼痛缓解和神经系统改善情况将患者分为对照组（好转52例）和观察组（好转28例）。评估放射学融合率和日本骨科协会（JOA）评分。采用多变量logistic回归评估独立预测因素。结果：对照组在最终随访时JOA评分明显改善（14.49±0.25比术前10.74±1.16,P P P = 0.002）。多因素分析发现年龄≥55岁（观察组：62.35±5.41 vs.对照组：51.47±6.37,P P P = 0.003）和基线疾病严重程度是不良结局的独立危险因素（P P = 0.003）。结论：高龄、低骨密度和术后并发症严重影响BAK/C融合ACDF的预后。术前优化骨密度，明智地使用增强型多层固定，以及精确的患者选择是改善预后的关键。这些发现为个性化临床决策提供了基于证据的见解。
期刊介绍：
Evidence of surgical interventions go back to prehistoric times. Since then, the field of surgery has developed into a complex array of specialties and procedures, particularly with the advent of microsurgery, lasers and minimally invasive techniques. The advanced skills now required from surgeons has led to ever increasing specialization, though these still share important fundamental principles.
Frontiers in Surgery is the umbrella journal representing the publication interests of all surgical specialties. It is divided into several “Specialty Sections” listed below. All these sections have their own Specialty Chief Editor, Editorial Board and homepage, but all articles carry the citation Frontiers in Surgery.
Frontiers in Surgery calls upon medical professionals and scientists from all surgical specialties to publish their experimental and clinical studies in this journal. By assembling all surgical specialties, which nonetheless retain their independence, under the common umbrella of Frontiers in Surgery, a powerful publication venue is created. Since there is often overlap and common ground between the different surgical specialties, assembly of all surgical disciplines into a single journal will foster a collaborative dialogue amongst the surgical community. This means that publications, which are also of interest to other surgical specialties, will reach a wider audience and have greater impact.
The aim of this multidisciplinary journal is to create a discussion and knowledge platform of advances and research findings in surgical practice today to continuously improve clinical management of patients and foster innovation in this field.
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