Treatment of Cervical Adjacent Segment Pathology
Notice bibliographique
Résumé
STUDY DESIGN: Systematic review. OBJECTIVE: To critically review and summarize evidence on the treatment of cervical adjacent segment pathology (ASP). SUMMARY OF BACKGROUND DATA: Clinical ASP (CASP) refers to clinically significant symptoms and signs (radiculopathy, myelopathy, mechanical pain) that correlate with imaging evidence of degeneration at motion segments adjacent to a previous intervention. Despite growing awareness of the long-term risks of ASP, fusion is the most commonly performed type of cervical spine surgery. There are little data regarding the optimal treatment for cervical CASP. METHODS: A systematic search of PubMed, the Cochrane Library, and Google Scholar for literature published through March 2, 2012, was conducted to answer 2 key questions: (1) What is the comparative effectiveness and safety of operative versus nonoperative treatments for cervical CASP?; and (2) Describe the outcomes of surgical treatment of cervical CASP. RESULTS: A total of 5 studies were selected for inclusion. No comparative studies were found to answer question 1. We found 1 comparative study and 4 case series of more than 10 patients that addressed question 2: 2 studies described fusion (1 comparing discectomy with corpectomy), 2 evaluated laminoplasty, and 1 reported on use of artificial discs. No studies on use of laminectomy, foraminotomy, or posterior decompression and fusion were found. Two poor-quality (level of evidence III) retrospective cohort studies compared anterior cervical discectomy and fusion with corpectomy for the treatment of CASP, but 1 study was too small to draw meaningful comparisons and was considered a case series. The other reported a 37.5% risk difference favoring corpectomy; however, most patients in both treatment groups had excellent or good clinical results, and the study had significant methodological limitations that limit comparison of anterior cervical discectomy and fusion with corpectomy (nonrandomized allocation to treatment groups, limited follow-up, small numbers of patients). No studies describing subsequent development or advancement of ASP after reconstructive surgery were found. CONCLUSION: Surgical options to treat cervical CASP include fusion, laminoplasty, and disc arthroplasty. There are no comparative data to guide operative versus nonoperative management. Favorable results are reported for each of these operative strategies, but small patient numbers and largely retrospective methodology limit definitive conclusions. There were conflicting data regarding the risk of single- versus multilevel fusion with respect to arthrodesis rates, and very low evidence that fusions at spinal levels caudal to ASP have a higher pseudoarthrosis risk compared with rostral levels. CONSENSUS STATEMENT: 1. Arthroplasty, laminoplasty, and fusion for treatment of cervical CASP were described in the studies found. These seem to be effective for treatment of cervical CASP. No studies on foraminotomy, laminectomy, and posterior decompression and fusion were found. LEVEL OF EVIDENCE: Insufficient. Strength of Statement: Strong. Recommendation no.1: Despite the importance of this topic, a dearth of literature was found. We recommend further studies on this topic. LEVEL OF EVIDENCE: Insufficient. Strength of Statement: Strong.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,002 | 0,001 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».