The Imaging Characteristics Of Adjacent Segment Degeneration In Congenital Cervical Fusion (Klippel-feil Syndrome) And The Analogous Significance To Adjacent Segment Disease

Objectives:Klippel-Feil syndrome is one of the unfrequent congenital malformation cervical fusion.It usually involved two or more vertebra,shows all or part of the vertebral body congenital fusion.Since 1955,after Smith and Robinson reported the anterior cervical discectomy and fusion,ACDF came to be the standard measure to cure the Cervical Spondylosis.But the long-term follow-up shows that it can lead to serious adjacent segment disease.Therefore the adjacent segment degeneration and disease came to cause much more attention of the orthopedic clinical physicians than ever.In our research,we use the image data of the klippel-feil syndrome patients and the control group person,in order to conclusion the disc degeneration characteristics in klippel-feil syndrome and discuss the relationship between fusion and adjacent segment degeneration.Methods:The data were retrospectively analyzed.Collecting X-ray and MRI data of 94 patients with klippel-feil syndrome and random collection of 194 cases as the control group between March 2011 and May 2015.Case group including 39 males and 55 females,and the mean age was 48.5years.Counting about fusion segments: Single segmental fusion 87:including 34 C2/3,13 C3/4,12 C4/5,13 C5/6,9 C6/7,6 C7/T1.Two and more segmental fusion 7,including 1 C3/4/5;1 C5/6/7;1 C2/3,C4/5;1 C2/3,C5/6;1 C4/5,C7/T1;1 C2/3/4,C5/6;1 C3/4,C5/6/7.Counting about Miyazaki degeneration grade:none case in grade 1,47 cases in grade 2,207 cases in grade 3,182 cases in grade 4,25 cases in grade 5.Control group including 88 males and 106 females,and the mean age was 48.59 years.Counting about Miyazaki degeneration grade:8 cases in grade 1,127 cases in grade 2,502 cases in grade 3,490 cases in grade 4,37 cases in grade 5.According different standards,the case group and control group divided into several groups: the adjacent segment group and the nonadjacent segment group,the cephalic segment group and caudal segment group,the male group and the female group,the young and middle-aged group and the older age-group.Using the nonparametric test to compare the data between different groups by SPSS 13.0.The statistics type select Mann-Whitney U,inspection level(P=0.05).Results:The case group including 39 males and 55 females,and the mean age was 48.5years.The control group including 88 males and 106 females,and the mean age was 48.59 years.The age and gender was no significant different between case group and control group.There was significant different between adjacent segment and nonadjacent segment in congenital cervical fusion group,P<0.001.The difference between cephalic segment and caudal segment was not significant,P=0.299.There was significant different between male group and female group in the case group,P<0.001.There was significant different between the young and middle-aged group and the older age-group in the case group,P<0.001.There is significant different between the young and middle-aged group and the older age-group in the control group,P<0.001.The difference between case group and control group was not significant,P=0.599.There was significant different between adjacent segment in congenital cervical fusion group and the control group,P<0.001.The difference between nonadjacent segment in congenital cervical fusion group and the control group was not significant,P<0.003.Conclusions:Fusion is the most critical factors in the adjacent segment degeneration with Klippel-Feil syndrome.Based on the similarity between congenital cervical fusion and the anterior cervical discectomy and fusion,we can inferred that fusion is also the primary cause of the adjacent segment degeneration after the anterior cervical discectomy and fusion.