颈椎矢状面术后失衡对脊髓型颈椎病手术后的疗效有负面影响。
Postoperative cervical sagittal imbalance negatively affects outcomes after surgery for cervical spondylotic myelopathy.
作者信息
Roguski Marie, Benzel Edward C, Curran Jill N, Magge Subu N, Bisson Erica F, Krishnaney Ajit A, Steinmetz Michael P, Butler William E, Heary Robert F, Ghogawala Zoher
机构信息
*Department of Neurosurgery, Alan and Jacqueline Stuart Spine Research Center, Lahey Hospital and Medical Center, Burlington, MA †Department of Neurosurgery, Tufts University School of Medicine, Boston, MA ‡Harvard School of Public Health, Harvard University, Boston, MA §The Center for Spine Health and Department of Neurosurgery, Cleveland Clinic, Cleveland, OH ¶Department of Neurosurgery, University of Utah, Salt Lake City, UT ∥MetroHealth Spine Center and Department of Neurosurgery, Case Western Reserve University School of Medicine, Cleveland, OH **Department of Neurosurgery, Massachusetts General Hospital, Boston, MA; and ††Department of Neurosurgery, Rutgers, The State University of New Jersey, New Jersey Medical School, Newark, NJ.
出版信息
Spine (Phila Pa 1976). 2014 Dec 1;39(25):2070-7. doi: 10.1097/BRS.0000000000000641.
STUDY DESIGN
Prospective observational cohort study.
OBJECTIVE
To determine if postoperative cervical sagittal balance is an independent predictor of health-related quality of life outcome after surgery for cervical spondylotic myelopathy.
SUMMARY OF BACKGROUND DATA
Both ventral and dorsal fusion procedures for CSM are effective at reducing the symptoms of myelopathy. The importance of cervical sagittal balance in predicting overall health-related quality of life outcome after ventral versus dorsal surgery for CSM has not been previously explored.
METHODS
A prospective, nonrandomized cohort of 49 patients undergoing dorsal and ventral fusion surgery for CSM was examined. Preoperative and postoperative C2-C7 sagittal vertical axis was measured on standing lateral cervical spine radiographs. Outcome was assessed with 2 disease-specific measures-the modified Japanese Orthopedic Association scale and the Oswestry Neck Disability Index and 2 generalized outcome measures-the Short-Form 36 physical component summary (SF-36 PCS) and Euro-QOL-5D. Assessments were performed preoperatively, and at 3 months, 6 months, and 1 year postoperatively. Statistical analyses were performed using SAS version 9.3 (SAS Institute).
RESULTS
Most patients experienced improvement in all outcome measures regardless of approach. Both preoperative and postoperative C2-C7 sagittal vertical axis measurements were independent predictors of clinically significant improvement in SF-36 PCS scores (P = 0.03 and P = 0.02). The majority of patients with C2-C7 sagittal vertical axis values greater than 40 mm did not improve from an overall health-related quality of life perspective (SF-36 PCS) despite improvement in myelopathy. The postoperative sagittal balance value was inversely correlated with a clinically significant improvement of SF-36 PCS scores in patients undergoing dorsal surgery but not ventral surgery (P = 0.03 vs. P = 0.93).
CONCLUSION
Preoperative and postoperative sagittal balance measurements independently predict clinical outcomes after surgery for CSM.
LEVEL OF EVIDENCE
研究设计
前瞻性观察队列研究。
目的
确定颈椎病脊髓病手术后颈椎矢状面平衡是否是健康相关生活质量结果的独立预测因素。
背景数据总结
颈椎病脊髓病的前路和后路融合手术在减轻脊髓病症状方面均有效。此前尚未探讨颈椎矢状面平衡在预测颈椎病脊髓病前路与后路手术后总体健康相关生活质量结果中的重要性。
方法
对49例接受颈椎病脊髓病后路和前路融合手术的患者进行前瞻性、非随机队列研究。在站立位颈椎侧位X线片上测量术前和术后C2-C7矢状垂直轴。采用2种疾病特异性指标——改良日本骨科协会量表和Oswestry颈部功能障碍指数，以及2种一般指标——简明健康状况调查量表身体成分总结（SF-36 PCS）和欧洲五维健康量表（Euro-QOL-5D）进行结果评估。在术前、术后3个月、6个月和1年进行评估。使用SAS 9.3版（SAS研究所）进行统计分析。
结果
无论采用何种手术方式，大多数患者在所有结果指标上均有改善。术前和术后C2-C7矢状垂直轴测量值均是SF-36 PCS评分临床显著改善的独立预测因素（P = 0.03和P = 0.02）。尽管脊髓病有所改善，但从总体健康相关生活质量（SF-36 PCS）角度来看，大多数C2-C7矢状垂直轴值大于40 mm的患者并未改善。术后矢状面平衡值与接受后路手术患者的SF-36 PCS评分临床显著改善呈负相关，但与前路手术患者无关（P = 0.03对P = 0.93）。
结论
术前和术后矢状面平衡测量可独立预测颈椎病脊髓病手术后的临床结果。
证据级别
2级。
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