Yang Peng, Li Yongqian, Li Jia, Shen Yong
Department of Neurosurgery, Affiliated Hospital of North China University of Science and Technology, Tangshan.
Department of Orthopedic Surgery.
Ther Clin Risk Manag. 2017 Aug 29;13:1119-1125. doi: 10.2147/TCRM.S138990. eCollection 2017.
This retrospective study investigated an association between preoperative T1 slope and surgical and adjacent segment degeneration (SASD) after Bryan cervical disc arthroplasty (BCDA) in patients with cervical degenerative disc disease.
Based on preoperative standing lateral radiographs, 90 patients were classified according to T1 slope that was higher or lower than the 50th percentile (high T1 or low T1, 28 and 62 patients, respectively). Patients were also classified as SASD or non-SASD (38 and 52 patients, respectively) determined by radiographs at final follow-up. Visual analog scale (VAS) and Neck Disability Index (NDI) scores for neck and arm pain were noted, and changes in the sagittal alignment of the cervical spine (SACS), functional spinal unit (FSU) angle, and FSU range of motion (ROM) were also noted. Univariate and multivariate logistic regression analyses were performed to determine the risk factors for SASD.
The overall rate of SASD was 42.2% (38/90). The SACS, FSU angle, FSU ROM, and SASD rates of the high T1 and low T1 slope groups were significantly different at the last follow-up. The NDI and VAS scores of the high T1 slope group were significantly greater than those of the low T1 slope. The multivariate logistic regression analysis showed that high T1 slope and endplate coverage discrepancy (ie, residual space behind the prosthesis) were significant risk factors for SASD after BCDA.
High T1 slope and endplate coverage discrepancy were associated with SASD after BCDA. Patients with a high preoperative T1 slope have a smaller FSU angle and more neck pain after BCDA.
本回顾性研究调查了颈椎间盘退变疾病患者行Bryan颈椎间盘置换术（BCDA）后，术前T1斜率与手术及相邻节段退变（SASD）之间的关联。
根据术前站立位侧位X线片，将90例患者按T1斜率高于或低于第50百分位数分为两组（高T1组和低T1组，分别为28例和62例）。根据末次随访时的X线片，患者还被分为SASD组和非SASD组（分别为38例和52例）。记录视觉模拟量表（VAS）和颈部残疾指数（NDI）的颈部及手臂疼痛评分，同时记录颈椎矢状位排列（SACS）、功能脊柱单元（FSU）角度及FSU活动度（ROM）的变化。进行单因素和多因素逻辑回归分析以确定SASD的危险因素。
SASD的总体发生率为42.2%（38/90）。末次随访时，高T1斜率组和低T1斜率组的SACS、FSU角度、FSU ROM及SASD发生率存在显著差异。高T1斜率组的NDI和VAS评分显著高于低T1斜率组。多因素逻辑回归分析显示，高T1斜率和终板覆盖差异（即假体后方的残余间隙）是BCDA术后发生SASD的显著危险因素。
高T1斜率和终板覆盖差异与BCDA术后的SASD相关。术前T1斜率高的患者在BCDA术后FSU角度较小且颈部疼痛更明显。
