颈椎畸形的新型角度测量考虑了上颈椎代偿和矢状面排列。
Novel Angular Measures of Cervical Deformity Account for Upper Cervical Compensation and Sagittal Alignment.
作者信息
Protopsaltis Themistocles S, Lafage Renaud, Vira Shaleen, Sciubba Daniel, Soroceanu Alex, Hamilton Kojo, Smith Justin, Passias Peter G, Mundis Gregory, Hart Robert, Schwab Frank, Klineberg Eric, Shaffrey Christopher, Lafage Virginie, Ames Christopher
机构信息
*Department of Orthopedic Surgery, New York University Langone Hospital for Joint Diseases †Hospital for Special Surgery, Spine Service, New York, NY ‡Department of Neurosurgery, Johns Hopkins University Hospital, Baltimore, MD §Department of Surgery, University of Calgary, Calgary AB, Canada ∥Department of Orthopaedic Surgery, Pittsburg University Medical Center, Pittsburg, PA ¶Department of Neurosurgery, University of Virginia School of Medicine, Charlottesville, VA #San Diego Center for Spinal Disorders, La Jolla ††Department of Orthopedic Surgery, University of California Davis, Sacramento ‡‡Department of Neurosurgery, University of California San Francisco, San Francisco, CA **Department of Orthopedic Surgery, Oregon Health Sciences University, Portland, OR.
出版信息
Clin Spine Surg. 2017 Aug;30(7):E959-E967. doi: 10.1097/BSD.0000000000000554.
STUDY DESIGN
This is a retrospective review of a prospective multicenter database.
OBJECTIVE
This study introduces 2 new cervical alignment measures accounting for both cervical deformity (CD) and upper cervical compensation.
SUMMARY OF BACKGROUND DATA
Current descriptions of CD like the C2-C7 sagittal vertical axis (cSVA) do not account for compensatory mechanisms such as C0-C2 lordosis and pelvic tilt, which makes surgical planning difficult. The craniocervical angle (CCA) combines the slope of McGregor's line and the inclination from C7 to the hard palate. The C2-pelvic tilt (CPT) combines C2 tilt and pelvic tilt. Like the T1 pelvic angle, CPT is less affected by lower extremity and pelvic compensation.
METHODS
Novel and existing CD measures were correlated in 781 patients from a thoracolumbar deformity (TLD) database and 61 patients from a prospective CD database. CD patients were subanalyzed by region of deformity driver: cervical or cervico-thoracic junction. TLD patients were substratified according to whether or not they had CD as well, where CD was defined as cSVA>4 cm or T1 slope minus cervical lordosis mismatch (TS-CL) >20.
RESULTS
TLD cohort: mean cSVA was 31.7±17.8 mm. Subanalysis of TLD patients with CD versus no-CD demonstrated significant differences in CCA (56.2 vs. 60.6, P<0.001) and CPT (32.6 vs. 19.3, P<0.001). CCA and CPT correlated with cSVA (r=-0.488/r=0.418, P<0.001) and C0-C2 lordosis (r=-0.630/r=0.289,P<0.001). CD cohort: mean cSVA was 47.3±32.2 mm. CCA and CPT correlated with cSVA (r=-0.811/r=0.657, P<0.001) and C0-C2 lordosis (r=-0.656/r=0.610, P<0.001). CD cohort subanalysis indicated that CT patients were significantly more deformed by cSVA (71.3 vs 24.0 mm, P<0.001), CCA (47.1 vs 59.1 degrees, P<0.001), and CPT (63.3 vs 43.8 degrees, P=0.002). Using linear regression analysis, cSVA of 4 cm corresponded to CCA of 53.2 degrees (r=0.5) and CPT of 48.5 degrees (r=0.4).
CONCLUSIONS
CCA and CPT account for both cervical sagittal alignment and upper cervical compensation and can be utilized in assessment of cervical alignment.
研究设计
这是一项对前瞻性多中心数据库的回顾性分析。
目的
本研究引入了2种新的颈椎对线测量方法，该方法兼顾了颈椎畸形（CD）和上颈椎代偿情况。
背景数据总结
目前对CD的描述，如C2-C7矢状垂直轴（cSVA），未考虑诸如C0-C2前凸和骨盆倾斜等代偿机制，这给手术规划带来困难。颅颈角（CCA）结合了麦格雷戈线的斜率以及从C7到硬腭的倾斜度。C2-骨盆倾斜度（CPT）结合了C2倾斜度和骨盆倾斜度。与T1骨盆角一样，CPT受下肢和骨盆代偿的影响较小。
方法
在来自胸腰椎畸形（TLD）数据库的781例患者和来自前瞻性CD数据库的61例患者中，对新的和现有的CD测量方法进行相关性分析。CD患者根据畸形驱动区域进行亚组分析：颈椎或颈胸交界处。TLD患者也根据是否存在CD进行分层，其中CD定义为cSVA>4 cm或T1斜率减去颈椎前凸不匹配（TS-CL）>20。
结果
TLD队列：平均cSVA为31.7±17.8 mm。对有CD和无CD的TLD患者进行亚组分析显示，CCA（56.2对60.6，P<0.001）和CPT（32.6对19.3，P<0.001）存在显著差异。CCA和CPT与cSVA（r=-0.488/r=0.418，P<0.001）以及C0-C2前凸（r=-0.630/r=0.289，P<0.001）相关。CD队列：平均cSVA为47.3±32.2 mm。CCA和CPT与cSVA（r=-0.811/r=0.657，P<0.001）以及C0-C2前凸（r=-0.656/r=0.610，P<0.001）相关。CD队列亚组分析表明，颈胸段患者的cSVA（71.3对24.0 mm，P<0.001）、CCA（47.1对59.1度，P<0.001）和CPT（63.3对43.8度，P=0.002）畸形程度明显更高。使用线性回归分析，4 cm的cSVA对应53.2度的CCA（r=0.5）和48.5度的CPT（r=0.4）。
结论
CCA和CPT兼顾了颈椎矢状对线和上颈椎代偿情况，可用于评估颈椎对线。
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