Tang Jessica A, Scheer Justin K, Smith Justin S, Deviren Vedat, Bess Shay, Hart Robert A, Lafage Virginie, Shaffrey Christopher I, Schwab Frank, Ames Christopher P
*Department of Neurological Surgery, University of California, San Francisco, San Francisco, California; ‡University of California, San Diego, School of Medicine, San Diego, California; §Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, California; ¶Rocky Mountain Scoliosis and Spine Center, Denver, Colorado; ‖Department of Orthopaedic Surgery, Oregon Health and Science University, Portland, Oregon; #Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York; **Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia.
Neurosurgery. 2015 Mar;76 Suppl 1:S14-21; discussion S21. doi: 10.1227/01.neu.0000462074.66077.2b.
Positive spinal regional and global sagittal malalignment has been repeatedly shown to correlate with pain and disability in thoracolumbar fusion.
To evaluate the relationship between regional cervical sagittal alignment and postoperative outcomes for patients receiving multilevel cervical posterior fusion.
From 2006 to 2010, 113 patients received multilevel posterior cervical fusion for cervical stenosis, myelopathy, and kyphosis. Radiographic measurements made at intermediate follow-up included the following: (1) C1-C2 lordosis, (2) C2-C7 lordosis, (3) C2-C7 sagittal vertical axis (C2-C7 SVA; distance between C2 plumb line and C7), (4) center of gravity of head SVA (CGH-C7 SVA), and (5) C1-C7 SVA. Health-related quality-of-life measures included neck disability index (NDI), visual analog pain scale, and SF-36 physical component scores. Pearson product-moment correlation coefficients were calculated between pairs of radiographic measures and health-related quality-of-life scores.
Both C2-C7 SVA and CGH-C7 SVA negatively correlated with SF-36 physical component scores (r =-0.43, P< .001 and r =-0.36, P = .005, respectively). C2-C7 SVA positively correlated with NDI scores (r = 0.20, P = .036). C2-C7 SVA positively correlated with C1-C2 lordosis (r = 0.33, P = .001). For significant correlations between C2-C7 SVA and NDI scores, regression models predicted a threshold C2-C7 SVA value of approximately 40 mm, beyond which correlations were most significant.
Our findings demonstrate that, similar to the thoracolumbar spine, the severity of disability increases with positive sagittal malalignment following surgical reconstruction.
在胸腰椎融合术中，脊柱局部和整体矢状面的正位排列不良已被反复证明与疼痛和功能障碍相关。
评估接受多节段颈椎后路融合术患者的颈椎局部矢状面排列与术后结果之间的关系。
2006年至2010年，113例患者因颈椎管狭窄、脊髓病和后凸畸形接受了多节段颈椎后路融合术。中期随访时的影像学测量包括：（1）C1-C2前凸；（2）C2-C7前凸；（3）C2-C7矢状垂直轴（C2-C7 SVA；C2铅垂线与C7之间的距离）；（4）头部重心矢状垂直轴（CGH-C7 SVA）；（5）C1-C7 SVA。与健康相关的生活质量指标包括颈部功能障碍指数（NDI）、视觉模拟疼痛量表和SF-36身体成分评分。计算影像学测量指标与健康相关生活质量评分之间的Pearson积矩相关系数。
C2-C7 SVA和CGH-C7 SVA均与SF-36身体成分评分呈负相关（分别为r = -0.43，P <.001和r = -0.36，P =.005）。C2-C7 SVA与NDI评分呈正相关（r = 0.20，P =.036）。C2-C7 SVA与C1-C2前凸呈正相关（r = 0.33，P =.001）。对于C2-C7 SVA与NDI评分之间的显著相关性，回归模型预测C2-C7 SVA的阈值约为40 mm，超过该值相关性最为显著。
我们的研究结果表明，与胸腰椎相似，手术重建后矢状面排列不良呈阳性时，残疾程度会增加。
