[1]张利鹏 刘阳 王显 郑银福 杨薇 杨政伟.颈椎融合术后邻近节段疾病的诊疗进展[J].中华老年骨科与康复电子杂志,2026,(02):123-128.[doi:10.3877/cma.j.issn.2096-0263.2026.02.009]
　Zhang Lipeng,Liu Yang,Wang Xian,et al.Progress in diagnosis and treatment of adjacent segment diseases after cervical fusion[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2026,(02):123-128.[doi:10.3877/cma.j.issn.2096-0263.2026.02.009]
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颈椎融合术后邻近节段疾病的诊疗进展()
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中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

卷:
期数:
2026年02期
页码:
123-128
栏目:
综述
出版日期:
2026-04-05

文章信息/Info

Title:
Progress in diagnosis and treatment of adjacent segment diseases after cervical fusion
作者:
张利鹏 刘阳 王显 郑银福 杨薇 杨政伟
402360 重庆市大足区中医院骨伤科
Author(s):
Zhang Lipeng;  Liu Yang;  Wang Xian;  Zheng Yinfu;  Yang Wei;  Yang Zhengwei.
Dazu District Hospital of Traditional Chinese Medicine, Chongqing 402360, China
关键词:
颈椎融合术;  邻近节段疾病;  治疗;  诊疗现状
Keywords:
Cervical fusion;  Adjacent segment disease;  Treatment;  Diagnosis and treatment status
DOI:
10.3877/cma.j.issn.2096-0263.2026.02.009
文献标志码:
A
摘要:
颈椎融合术后邻近节段退变（ASDeg）和邻近节段疾病（ASD）是影响远期疗效的核心问题，影像学发病率达16%～96%，有症状ASD发生率为1.8%～36%，约40%需二次手术。核心机制为融合导致邻近节段生物力学负荷异常增加（屈曲时近端间盘压力升高73.2%），加速退变。危险因素涵盖术前（高龄、椎管狭窄、多节段退变）、术中（多节段融合、钢板位置不当）及术后（颈椎曲度丢失）等多维度。ASD诊断需结合病史、神经受压症状（颈痛、肢体麻木无力）及影像学表现（椎间隙狭窄、骨赘、椎管受压）。治疗需个体化：轻症非手术治疗无效或神经压迫明显者考虑手术。颈椎前路椎间盘切除减压融合术（ACDF）翻修仍是主流，但二次手术并发症风险高；零切迹融合器可显著降低吞咽困难发生率（0%vs5.2%）；后路椎板成形术适用于多节段脊髓受压；颈椎间盘置换术（CDA）保留活动度，可能延缓邻节段退变。后路脊柱内镜技术（椎间盘切除/椎管减压/神经根管减压）因规避前路瘢痕风险，具有微创、恢复快、对稳定性影响小等优势，是新兴治疗方向，但需更多研究验证其长期疗效。未来需加强循证指南制定及技术创新以优化防治策略。
Abstract:
Adjacent segment degeneration (ASDeg) and adjacent segment disease (ASD) after cervical fusion are the core issues affecting long-term outcomes. The imaging incidence is 16% to 96%, and the incidence of symptomatic ASD is 1.8% to 36%. About 40% require secondary surgery. The core mechanism is that fusion causes an abnormal increase in biomechanical load on adjacent segments (a 73.2% increase in proximal disc pressure during flexion) and accelerates degeneration. Risk factors include multiple dimensions such as preoperative (advanced age, spinal stenosis, multi-level degeneration), intraoperative (multi-level fusion, improper plate positioning) and postoperative (loss of cervical curvature). The diagnosis of ASD requires combining medical history, nerve compression symptoms (neck pain, limb numbness and weakness) and imaging findings (intervertebral space stenosis, osteophytes, spinal canal compression). Treatment needs to be individualized: For mild cases, surgery should be considered for those who fail to respond to non-surgical treatment or have obvious nerve compression. Revision of anterior cervical discectomy and decompression fusion (ACDF) is still the mainstream, but the risk of secondary surgical complications is high; zero-profile fusion cages can significantly reduce the incidence of dysphagia (0% versus 5.2%); posterior laminoplasty is suitable for multi-level spinal cord compression; cervical disc arthroplasty (CDA) preserves range of motion and may delay adjacent segment degeneration. Posterior spinal endoscopic technology (discectomy/spinal canal decompression/nerve root canal decompression) is an emerging treatment direction because it avoids the risk of anterior scarring, has the advantages of minimally invasive, rapid recovery, and little impact on stability. However, more research is needed to verify its long-term efficacy. In the future, it is necessary to strengthen the formulation of evidence-based guidelines and technological innovation to optimize prevention and control strategies.

备注/Memo

备注/Memo:
基金项目：重庆市自然科学基金项目（2023NSCQ-MSX4601）
更新日期/Last Update: 2026-05-19