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在手术前的Pfirrmann分级和前椎间盘切除和融合后的相邻细分退化之间的关系

Jonathan F Dalton¹, Robert J Oris, Joshua Mathew

¹From the Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA.

The Journal of the American Academy of Orthopaedic Surgeons

|December 30, 2025

概括

在相邻的磁盘中高的手术前Pfirrmann等级预测了宫融合后更严重的退化,特别是减少了磁盘高度. 然而,相邻细分体疾病的修订率在各组中仍然相似.

科学领域:

脊柱外科手术脊柱外科手术
退行性磁盘疾病的疾病.
放射性评估的放射性评估

背景情况:

在前宫解压和融合 (ACDF) 之后,相邻细分病 (ASD) 是一个令人担忧的问题.
术前评估相邻的椎间盘健康状况对于预测ASD风险至关重要.
皮尔曼分类是评估磁盘退化在MRI上的标准方法.

研究的目的:

调查使用Pfirrmann分类进行分级的手术前邻近磁盘退化与随后发展ASD的风险之间的关联.
为了确定更高的手术前Pfirrmann等级是否预测在ACDF后的相邻水平上更糟糕的放射性结果.

主要方法:

对56名接受ACDF (2013-2020) 术前MRI和2年随访的患者进行了回顾性审查.
与融合相邻的术前盘被使用修改的Pfirrmann尺度 (等级I-IV) 分类,分为低 (I-II) 或高 (III-IV) 退化.
术后放射性退化被评估使用评分系统评估盘高度,骨质细胞和硬化在2年.

主要成果:

分析了56名患者和114个相邻水平;51个水平具有高的Pfirrmann变性.
在2年后,高的手术前Pfirrmann等级独立预测了术后盘高度比率的降低 (P=0.025) 和更严重的盘高度得分 (P=0.030).
人口和手术因素 (年龄,性别,并发症指数,构造长度) 与手术前退行症严重程度相关.

结论:

在相邻的磁盘中增加的术前Pfirrmann级是恶化相邻段变性,特别是减少磁盘高度的显著预测因素,在ACDF之后.
尽管退化增加了,但ASD修复手术的发生率在5年后在高和低的手术前退化组之间没有显著差异.

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