颈椎前路融合术后邻近节段退变的危险因素研究进展

颈椎前路椎间盘切除融合术(anterior cervical discectomy and fusion,ACDF)应用于临床近百年,取得了良好的临床疗效,被认为是治疗颈椎病的金标准。但融合术后邻近节段退变(adjacent segment degeneration,ASDeg)受到越来越多的关注,关于其发生机制的争论主要集中在融合术导致邻近节段生物应力的改变与年龄相关的自然退变。融合术后发生ASDeg将严重影响手术的中远期疗效,部分患者甚至需要二次手术治疗。为了降低甚至避免ASDeg的发生,临床上出现许多新的技术,诸如保留运动节段的人工椎间盘置换术,新兴的细胞移植技术等,但临床疗效仍需要大量的研究进行证实。因此,发现融合术后发生ASDeg的危险因素对于临床开展融合手术具有重要的意义。目前对于ASDeg危险因素的研究仍无统一认识,本文将从颈椎前路融合术后发生ASDeg的危险因素的研究进展及相应应对措施作一综述,以指导临床实践。

Research progress of risk factors of adjacent segment degeneration after anterior cervical discectomy and fusion

Anterior cervical discectomy and fusion (ACDF) has achieved good clinical results since it was used in clinic,and is considered as the gold standard for the treatment of cervical spondylosis. However,more and more attention has been paid to adjacent segment degeneration(ASDeg) after fusion,and the debate about its pathogenesis is mainly focused on the bio-machanical stress changes of adjacent segments caused by fusion and the result of the natural aging process. The occurrence of ASDeg after fusion seriously affect the med-and long-term outcome of surgery,and some patients even need secondary surgery. In order to reduce or even avoid the occurrence of ASDeg,many new techniques have emerged in clinic,such as artificial disc replacement with preservation of motor segments,emerging cell transplantation technology and so on,but the clinical effect still needs to be confirmed by a large number of studies. Therefore,finding the risk factors of ASDeg after fusion is of great significance for fusion surgery on the clinical work. At present,there is still no unified overview of the research on the risk factors of ASDeg. This article will review the research progress and corresponding countermeasures of the risk factors of ASDeg after ACDF,in order to guide the clinical application.