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| LI Guo,WU Jianfeng,HUANG Wending.Risk factors for postoperative subsidence of ROI-C in single-level anterior cervical discectomy and fusion[J].Chinese Journal of Spine and Spinal Cord,2016,(12):1063-1069. |
| Risk factors for postoperative subsidence of ROI-C in single-level anterior cervical discectomy and fusion |
| Received:July 20, 2016 Revised:August 29, 2016 |
| English Keywords:Anterior cervical discectomy and fusion Stand-alone cage Postoperative subsidence Cervical alignment |
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| English Abstract: |
| 【Abstract】 Objectives: To investigate and analyze the risk factors for postoperative subsidence of RIO-C in single-level anterior cervical discectomy and fusion(ACDF). Methods: Eighty-three patients who underwent single-level ACDF with ROI-C for cervical degenerative disc disease were included in this retrospective study. The factors such as age, sex, operative level, smoking history, bone mineral density(BMD), and preoperative sagittal cervical alignment(CA), operated segmental angle(SA), anterior/posterior disc height(ADH/PDH) in the lateral radiographs of cervical spine were collected. Patients were categorized into subsidence group(S group, n=22) and nonsubsidence group(N group, n=61) based on the loss of the disc height for 2mm. These clinical and radiographic factors were compared between two groups by using independent sample t-test or Chi-square test． Risk factors for postoperative subsidence of ROI-C in single-level ACDF were analyzed by multivariate Logistic regression. The likelihood ratios(LR) of risk factors were obtained by using χ2 test on the basis of a cutoff. Results: Subsidence occurred in 22(26.5%) of 83 patients. The incidence of subsidence into the anterior endplate was 63.6%(14/22). Mean age was 59.86±12.11 and 52.77±10.34 years(P=0.010) in group S and group N, while gender, surgery level, smoking history, BMD showed no significant differences between group S and group N(P>0.05). A significant difference was found with respect to preoperative CA, SA and ADH in group S compared with group N(P<0.001, P=0.031 and P<0.001, respectively), whereas there was no significant difference in PDH(P=0.092). Multivariate Logistic regression analysis revealed that the preoperative CA(P=0.014) and age(P=0.038) affected subsidence. The patients in each group were assigned to kyphotic or lordotic subgroup and senior or junior subgroup according to cervical alignment cutoff of 0 degree and age cutoff of 60 years respectively. The risk of ROI-C subsidence in the kyphotic subgroup was 12.5-fold greater than that in the lordotic subgroup(LR=12.529, P<0.001). The patients older than 60 years were 4.5-fold more likely to display subsidence than those younger than 60 years(LR=4.454, P=0.030). Conclusions: In single-level ACDF with ROI-C, the risk factors affecting postoperative cage subsidence are preoperative CA of kyphosis and age older than 60 years. The data suggest that spinal surgeons should cautiously consider the preoperative CA and/or age when deciding on the ROI-C for single-level ACDF to treat patients with degenerative disc disease. |
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