Division of Neurosurgery, University of Toronto and Toronto Western Hospital, University Health Netwrok, Toronto, Ontario, Canada.
Division of Orthopedic Surgery, University of Toronto and Toronto Western Hospital, University Health Netwrok, Toronto, Ontario, Canada.
Spine (Phila Pa 1976). 2018 Feb 15;43(4):248-254. doi: 10.1097/BRS.0000000000002307.
Sub-analysis of the prospective AOSpine CSM North America and International studies.
The aim of this study was to investigate the impact of cervical spine deformity on pre- and postoperative outcomes in fusion surgeries for degenerative cervical myelopathy.
The associations between cervical alignment and patient outcomes have been reported but are not well established in a myelopathy cohort. The impact of deformity correction in this population also needs to be elucidated.
A total of 757 patients were enrolled in two prospective international multicenter AOSpine studies. Among those who underwent anterior or posterior fusion surgeries, pre- and 1-year postoperative upright neutral lateral radiographs of cervical spine were investigated to measure C2-7 Cobb angle and C2-7 sagittal vertical axis (SVA). Patient outcome measures included the modified Japanese Orthopedic Association score for myelopathy severity, Neck Disability Index (NDI), and Short-form 36 (SF-36). These scores were compared between patients with and without cervical deformity, which was defined as C2-7 Cobb >10° kyphosis and/or SVA >40 mm.
A total of 178 patients were included with complete pre- and postoperative radiographs. SVA significantly increased postoperatively (27.4 vs. 30.7 mm, P = 0.004). All outcome measurement showed significant improvements above minimal clinically important differences. 23.6% of the patients had cervical deformity preoperatively; preoperative deformity was associated with worse preoperative NDI scores (45.7 vs. 38.9, P = 0.04). Postoperatively, those with deformity exhibited significantly lower SF-36 physical component scores (37.2 vs. 41.4, P = 0.048). However, when focusing on the preoperatively deformed cohort, we did not find any significant differences in the postoperative outcome scores between those with and without residual deformity.
There was a significant association between cervical deformity and both preoperative disease severity and postoperative outcomes; however, no impact of deformity correction was shown.
前瞻性 AOSpine CSM 北美和国际研究的亚分析。
本研究旨在探讨颈椎畸形对退行性颈椎病融合手术患者术前和术后结果的影响。
颈椎排列与患者预后之间的关系已被报道，但在颈椎病患者中尚未得到很好的证实。还需要阐明在这一人群中畸形矫正的影响。
共有 757 名患者参加了两项前瞻性国际多中心 AOSpine 研究。在前路或后路融合手术的患者中，调查了颈椎中立位侧位前后位片，以测量 C2-7 Cobb 角和 C2-7 矢状垂直轴（SVA）。患者的预后评估包括脊髓病严重程度的改良日本矫形协会评分、颈部残疾指数（NDI）和简式 36 健康调查量表（SF-36）。将有颈椎畸形和无颈椎畸形的患者进行比较，颈椎畸形定义为 C2-7 Cobb 角＞10°后凸和/或 SVA＞40mm。
共纳入 178 例患者，均有完整的术前和术后影像学资料。术后 SVA 显著增加（27.4 与 30.7mm，P=0.004）。所有的结果评估均显示出明显的改善，超过了最小临床重要差异。术前有 23.6%的患者存在颈椎畸形；术前畸形与较差的术前 NDI 评分相关（45.7 与 38.9，P=0.04）。术后，有畸形的患者 SF-36 生理成分评分明显较低（37.2 与 41.4，P=0.048）。然而，当关注术前畸形的患者时，我们没有发现术后残留畸形与无残留畸形患者之间的术后结果评分有任何显著差异。
颈椎畸形与术前疾病严重程度和术后结果均有显著关联；然而，畸形矫正并没有显示出影响。
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