The Journal of the American Academy of Orthopaedic Surgeons · 2025
Relationship Between Preoperative Pfirrmann Grading and Adjacent Segment Degeneration After Anterior Cervical Diskectomy and Fusion.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Dalton Jonathan F, Oris Robert J, Mathew Joshua, McCurdy Michael A, Alexander Tyler, Lin Ryan T, Ng Mitchell, Lee Yulia, Narayanan Rajkishen, Henry Tyler W, Lee Yunsoo, Kothari Purab, Sarikonda Advith, Dean Emmanuel, Cha Ryan, Kazantsev Maria, Mangan John J, Rihn Jeffrey A, Cha Thomas D, Kurd Mark F, Canseco Jose A, Hilibrand Alan S, Vaccaro Alexander R, Kepler Christopher K, Schroeder Gregory D
Аннотация
INTRODUCTION: To evaluate the association between preoperative adjacent segment disk health, evaluated by the Pfirrmann classification, and adjacent segment disease (ASD) risk.
METHODS: Patients who underwent anterior cervical decompression and fusion (2013 to 2020) with available preoperative magnetic resonance imaging and 2 years of radiographic follow-up were retrospectively identified. Patients with prior cervical surgery or malignancy/infection/trauma were excluded. Preoperative adjacent disk degeneration was evaluated with modified Pfirrmann classification (grades I to IV) and substratified as low (grades I to II) or high (grades III to IV). Radiographic degeneration 2 years postoperatively was assessed through a published radiograph scoring system based on disk height, osteophyte formation, and vertebral sclerosis. Statistical analyses were conducted to compare demographic, surgical, and radiographic outcomes between low and high degeneration groups.
RESULTS: Fifty-six patients (15 with high Pfirrmann degeneration at both levels, 21 with one high level, and 20 with no high levels) and a total of 114 levels (51 with high and 63 with low Pfirrmann degeneration) were included. Age, male sex, Charlson comorbidity index, and construct length all increased consistently from patients with neither adjacent level having high degeneration to one level to both levels ( P < 0.05). Linear regression showed that high preoperative adjacent Pfirrmann grade was independently predictive of decreased postoperative to preoperative adjacent disk height ratio (estimate: -0.16, P = 0.025) at 2 years postoperatively. Similarly, ordinal logistic regression showed that high preoperative adjacent Pfirrmann grade was independently predictive of more severe postoperative disk height score at 1 year (odds ratio: 3.9, P = 0.030). Both regression models included age, sex, Charlson comorbidity index, number of levels fused, indication for surgery (radiculopathy and myelopathy), and smoking status. The revision rate for ASD was similar between groups at 5 years.
CONCLUSION: High preoperative Pfirrmann grade at the disk level adjacent to anterior cervical decompression and fusion is predictive of worse adjacent segment degeneration, specifically decreased disk height at 2 years postoperatively. However, revision for ASD was similar at 5 years postoperatively.
METHODS: Patients who underwent anterior cervical decompression and fusion (2013 to 2020) with available preoperative magnetic resonance imaging and 2 years of radiographic follow-up were retrospectively identified. Patients with prior cervical surgery or malignancy/infection/trauma were excluded. Preoperative adjacent disk degeneration was evaluated with modified Pfirrmann classification (grades I to IV) and substratified as low (grades I to II) or high (grades III to IV). Radiographic degeneration 2 years postoperatively was assessed through a published radiograph scoring system based on disk height, osteophyte formation, and vertebral sclerosis. Statistical analyses were conducted to compare demographic, surgical, and radiographic outcomes between low and high degeneration groups.
RESULTS: Fifty-six patients (15 with high Pfirrmann degeneration at both levels, 21 with one high level, and 20 with no high levels) and a total of 114 levels (51 with high and 63 with low Pfirrmann degeneration) were included. Age, male sex, Charlson comorbidity index, and construct length all increased consistently from patients with neither adjacent level having high degeneration to one level to both levels ( P < 0.05). Linear regression showed that high preoperative adjacent Pfirrmann grade was independently predictive of decreased postoperative to preoperative adjacent disk height ratio (estimate: -0.16, P = 0.025) at 2 years postoperatively. Similarly, ordinal logistic regression showed that high preoperative adjacent Pfirrmann grade was independently predictive of more severe postoperative disk height score at 1 year (odds ratio: 3.9, P = 0.030). Both regression models included age, sex, Charlson comorbidity index, number of levels fused, indication for surgery (radiculopathy and myelopathy), and smoking status. The revision rate for ASD was similar between groups at 5 years.
CONCLUSION: High preoperative Pfirrmann grade at the disk level adjacent to anterior cervical decompression and fusion is predictive of worse adjacent segment degeneration, specifically decreased disk height at 2 years postoperatively. However, revision for ASD was similar at 5 years postoperatively.