Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Gyeonggi, Republic of Korea.
Spine (Phila Pa 1976). 2017 Dec 15;42(24):1859-1864. doi: 10.1097/BRS.0000000000002250.
STUDY DESIGN: Retrospective study. OBJECTIVE: To assess the long-term relationship between sagittal alignment of the cervical spine and patient-reported health-related quality-of-life (HRQOL) scores after multilevel posterior cervical fusion, and to explore whether an analog of T1 slope minus C2-C7 lordosis ('T1S-CL') impacts on patients' clinical outcomes. BACKGROUND: A 6-month follow-up study demonstrated that, similar to the thoracolumbar spine, the severity of disability increases with sagittal malalignment after cervical reconstruction surgery. METHODS: From 2007 to 2014, 31 consecutive patients having multilevel posterior cervical fusion for cervical stenosis, myelopathy, and deformities met inclusion criteria. To determine the true impact of the alignment on HRQOL, patients who have pseudarthrosis, a misplaced screw, junctional pathologies, or adjacent level disc herniation were excluded. Radiographic measurements included: C0-C2 lordosis, C2-C7 lordosis, C2-C7 sagittal vertical axis (SVA), T1 slope, and T1S-CL. Pearson correlation coefficients were calculated between pairs of radiographic measures and HRQOL. RESULTS: C2-C7 SVA positively correlated with neck disability index (NDI) scores (r = 0.550). For significant correlations between C2-C7 SVA and NDI scores, regression models predicted a threshold C2-C7 SVA value of 43.5 mm, beyond which correlations were most significant. The T1S-CL also correlated positively with C2-C7 SVA and NDI scores (r = 0.827 and r = 0.618, respectively). Results of the regression analysis indicated that a C2-C7 SVA value of 43.5 mm corresponded to a T1S-CL value of 22.2°. CONCLUSION: This minimum 2-year follow-up study showed that disability of the neck increased with cervical sagittal malalignment after surgical reconstruction and a greater T1S-CL mismatch was associated with a greater degree of cervical malalignment. Specifically, a T1S-CL mismatch greater than 22.2° corresponded to severe disability (NDI>25) and positive cervical sagittal malalignment, defined as C2-C7 SVA greater than 43.5 mm. LEVEL OF EVIDENCE: 4.
研究设计：回顾性研究。
目的：评估颈椎矢状位排列与多节段后路颈椎融合术后患者报告的健康相关生活质量（HRQOL）评分之间的长期关系，并探讨 T1 斜率减去 C2-C7 前凸（'T1S-CL'）是否会影响患者的临床结果。
背景：6 个月的随访研究表明，与胸腰椎相似，颈椎重建手术后，失状位畸形越严重，残疾程度越高。
方法：2007 年至 2014 年，31 例因颈椎狭窄、颈椎病和畸形而行多节段后路颈椎融合术的连续患者符合纳入标准。为了确定排列对 HRQOL 的真正影响，排除了假关节、螺钉错位、交界处病变或相邻节段椎间盘突出的患者。影像学测量包括：C0-C2 前凸、C2-C7 前凸、C2-C7 矢状垂直轴（SVA）、T1 斜率和 T1S-CL。Pearson 相关系数用于计算影像学测量值与 HRQOL 之间的关系。
结果：C2-C7 SVA 与颈部残疾指数（NDI）评分呈正相关（r=0.550）。对于 C2-C7 SVA 和 NDI 评分之间的显著相关性，回归模型预测 C2-C7 SVA 值超过 43.5mm 时相关性最显著。T1S-CL 也与 C2-C7 SVA 和 NDI 评分呈正相关（r=0.827 和 r=0.618）。回归分析结果表明，C2-C7 SVA 值为 43.5mm 对应 T1S-CL 值为 22.2°。
结论：这项至少 2 年的随访研究表明，颈椎矢状位重建后，颈椎失状位畸形导致颈痛加重，T1S-CL 失配程度越大，颈椎失状位畸形越严重。具体来说，T1S-CL 失配大于 22.2°与严重残疾（NDI>25）和阳性颈椎矢状位畸形（C2-C7 SVA 大于 43.5mm）相对应。
证据水平：4 级。
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