Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada.
Department of Neurosurgery, University of Virginia, Charlottesville, Virginia.
Neurosurgery. 2018 Nov 1;83(5):1031-1039. doi: 10.1093/neuros/nyx574.
Despite the potential for profound impact of adult cervical deformity (ACD) on function and health-related quality of life (HRQOL), there are few high-quality studies that assess outcomes of surgical treatment for these patients.
To determine the impact of surgical treatment for ACD on HRQOL.
We conducted a prospective cohort study of surgically treated ACD patients eligible for 1-yr follow-up. Baseline deformity characteristics, surgical parameters, and 1-yr HRQOL outcomes were assessed.
Of 77 ACD patients, 55 (71%) had 1-yr follow-up (64% women, mean age of 62 yr, mean Charlson Comorbidity Index of 0.6, previous cervical surgery in 47%). Diagnoses included cervical sagittal imbalance (56%), cervical kyphosis (55%), proximal junctional kyphosis (7%) and coronal deformity (9%). Posterior fusion was performed in 85% (mean levels = 10), and anterior fusion was performed in 53% (mean levels = 5). Three-column osteotomy was performed in 24% of patients. One year following surgery, ACD patients had significant improvement in Neck Disability Index (50.5 to 38.0, P < .001), neck pain numeric rating scale score (6.9 to 4.3, P < .001), EuroQol 5 dimension (EQ-5D) index (0.51 to 0.66, P < .001), and EQ-5D subscores: mobility (1.9 to 1.7, P = .019), usual activities (2.2 to 1.9, P = .007), pain/discomfort (2.4 to 2.1, P < .001), anxiety/depression (1.8 to 1.5, P = .014).
Based on a prospective multicenter series of ACD patients, surgical treatment provided significant improvement in multiple measures of pain and function, including Neck Disability Index, neck pain numeric rating scale score, and EQ-5D. Further follow-up will be necessary to assess the long-term durability of these improved outcomes.
尽管成人颈椎畸形（ACD）对功能和健康相关生活质量（HRQOL）有深远的影响，但评估这些患者手术治疗效果的高质量研究很少。
确定手术治疗 ACD 对 HRQOL 的影响。
我们对符合 1 年随访条件的接受手术治疗的 ACD 患者进行了前瞻性队列研究。评估了基线畸形特征、手术参数和 1 年 HRQOL 结果。
77 例 ACD 患者中有 55 例（71%）接受了 1 年随访（64%为女性，平均年龄 62 岁，平均 Charlson 合并症指数为 0.6，47%有颈椎手术史）。诊断包括颈椎矢状失平衡（56%）、颈椎后凸（55%）、近端交界后凸（7%）和冠状畸形（9%）。85%的患者行后路融合（平均融合节段为 10 个），53%的患者行前路融合（平均融合节段为 5 个）。24%的患者行三柱截骨。术后 1 年，ACD 患者的颈椎残障指数（NDI）显著改善（50.5 降至 38.0，P <.001），颈痛数字评分量表评分（6.9 降至 4.3，P <.001），欧洲五维健康量表（EQ-5D）指数（0.51 升至 0.66，P <.001），EQ-5D 各分项评分：活动能力（1.9 降至 1.7，P =.019），日常活动（2.2 降至 1.9，P =.007），疼痛/不适（2.4 降至 2.1，P <.001），焦虑/抑郁（1.8 降至 1.5，P =.014）。
基于 ACD 患者的前瞻性多中心系列研究，手术治疗显著改善了疼痛和功能的多个指标，包括颈椎残障指数、颈痛数字评分量表评分和 EQ-5D。需要进一步的随访来评估这些改善结果的长期持久性。
