The impact of over-distraction on adjacent segment pathology and cage subsidence in anterior cervical discectomy and fusion

被引:2
作者
Hsueh, Lan-Li [1 ,2 ,3 ]
Yeh, Yu-Cheng [1 ,2 ,3 ]
Lu, Meng-Ling [3 ,4 ]
Luo, Chi-An [1 ,2 ,3 ]
Chiu, Ping-Yeh [1 ,2 ,3 ]
Lai, Po-Liang [1 ,2 ,3 ]
Niu, Chi-Chien [1 ,2 ,3 ]
机构
[1] Chang Gung Mem Hosp, Dept Orthoped Surg, Linkou Branch, 5 Fuxing St, Taoyuan 333, Taiwan
[2] Chang Gung Mem Hosp, Bone & Joint Res Ctr, Linkou Branch, 5 Fuxing St, Taoyuan 333, Taiwan
[3] Chang Gung Univ, Coll Med, 259 Wenhua 1st Rd, Taoyuan 333, Taiwan
[4] Chang Gung Mem Hosp, Dept Orthoped Surg, Kaohsiung Branch, 123 DAPI Rd, Kaohsiung 833, Taiwan
关键词
INTERBODY FUSION; OUTCOMES; IMPLANT; FACET;
D O I
10.1038/s41598-023-44998-4
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
07 ; 0710 ; 09 ;
摘要
Over-distraction has been shown to be a risk factor for cage subsidence and postoperative neck pain after anterior cervical discectomy and fusion (ACDF). Biomechanical studies have demonstrated increased adjacent segment intradiscal pressure after ACDF. The purpose of this study is to determine if over-distraction of the index disc has an effect on adjacent segment pathology. A consecutive series of 145 patients who received primary ACDF for cervical degenerative pathologies from January 2010 to December 2017 were retrospectively reviewed. The patients were divided into: (1) Over-distraction group (postoperative-preoperative index disc height >= 2 mm), and (2) No-distraction group (postoperative-preoperative index disc height < 2 mm). Outcome measures included radiographic parameters, Japanese Orthopaedic Association (JOA) score, and incidences of cage subsidence, radiological and clinical adjacent segment pathologies (RASP and CASP) were compared between the two groups preoperatively, postoperatively, and at the final follow-up. The two groups were comparable with respect to age, follow-up length, JOA score, incidence of CASP, and radiographic parameters. The Over-distraction group (83 patients; 115 levels) had smaller preoperative index disc height (4.5 vs. 5.2 mm, p < 0.001), but taller postoperative index disc height (7.7 vs. 6.6 mm, p < 0.001) than No-distraction group (62 patients; 90 levels) Furthermore, significantly higher incidences of cage subsidence (47% vs. 31%, p = 0.04) and RASP (any progression: 48% vs. 15%, p < 0.001; progress >= 2 grades: 25% vs. 7%, p = 0.001) were observed in the Over-distraction group. The multivariate analysis indicated that over-distraction and multilevel fusion were independent risk factors for RASP. There were no clinical outcome differences between the Over-distraction group and the No-distraction group in ACDF. Over-distraction of the index level of >= 2 mm should be avoided because it significantly increases the incidences of RASP and cage subsidence.
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页数:10
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