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01.12.2019 | Research article | Ausgabe 1/2019 Open Access

BMC Musculoskeletal Disorders 1/2019

Association between sagittal balance and adjacent segment degeneration in anterior cervical surgery: a systematic review and meta-analysis

BMC Musculoskeletal Disorders > Ausgabe 1/2019
Yijian Zhang, Yijie Shao, Hao Liu, Junxin Zhang, Fan He, Angela Chen, Huilin Yang, Bin Pi
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1186/​s12891-019-2800-0) contains supplementary material, which is available to authorized users.
Yijian Zhang, Yijie Shao and Hao Liu contributed equally to this work.

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ASD is a relatively common degenerative alteration after cervical surgery which occurs above or below the fused segment. In addition, some patients may need reoperation to treat severe ASD after the primary surgery. It was considered that sagittal balance is correlated with postoperative clinical outcomes; however, few studies have reported the influence of sagittal balance on ASD. The present study is designed to investigate whether sagittal balance impacts the pathology of adjacent segment disease (ASD) in patients who undergo anterior cervical surgery for degenerative cervical disease.


Databases including Pubmed, Embase, Cochrane library, and Web of Science were used to search for literature published before June 2018. Review Manager 5.3 was used to perform the statistical analysis. Sagittal balance parameters before and after surgery were compared between patients with and without ASD. Weighted mean difference (WMD) was summarized for continuous data and P < 0.05 was set for the level of significance.


A total of 221 patients with ASD and 680 patients without ASD from seven articles were studied in this meta-analysis. There were no significant differences in most sagittal balance parameters between the two groups, except for postoperative cervical lordosis (CL) (WMD -3.30, CI -5.91, − 0.69, P = 0.01).


Some sagittal balance parameters may be associated with the development of ASD after anterior cervical surgery. Sufficient restoration of CL may decrease the incidence of ASD. The results in present study needed to be expanded carefully and further high-quality studies are warranted to investigate the impact of sagittal balance on ASD.
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