Department of Orthopedics, NYU Langone Orthopedic Hospital, New York, NY.
Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS.
Spine (Phila Pa 1976). 2018 Aug;43(16):1117-1124. doi: 10.1097/BRS.0000000000002610.
Retrospective review.
Determine whether alignment or myelopathy improvement drives patient outcomes after cervical deformity (CD) corrective surgery.
CD correction involves radiographic malalignment correction and procedures to improve motor function and pain. It is unknown whether alignment or myelopathy improvement drives patient outcomes.
Inclusion: Patients with CD with baseline/1-year radiographic and outcome scores. Cervical alignment improvement was defined by improvement in Ames CD modifiers. modified Japanese Orthopaedic Association (mJOA) improvement was defined as mild [15-17], moderate [12-14], severe [<12]. Patient groups included those who only improved in alignment, those who only improved in mJOA, those who improved in both, and those who did not improve. Changes in quality-of-life scores (neck disability index [NDI], EuroQuol-5 dimensions [EQ-5D], mJOA) were evaluated between groups.
A total of 70 patients (62 yr, 51% F) were included. Overall preoperative mJOA score was 13.04 ± 2.35. At baseline, 21 (30%) patients had mild myelopathy, 33 (47%) moderate, and 16 (23%) severe. Out of 70 patients 30 (44%) improved in mJOA and 13 (18.6%) met 1-year mJOA minimal clinically important difference. Distribution of improvement groups: 16/70 (23%) alignment-only improvement, 13 (19%) myelopathy-only improvement, 18 (26%) alignment and myelopathy improvement, and 23 (33%) no improvement. EQ-5D improved in 11 of 16 (69%) alignment-only patients, 11 of 18 (61%) myelopathy/alignment improvement, 13 of 13 (100%) myelopathy-only, and 10 of 23 (44%) no myelopathy/alignment improvement. There were no differences in decompression, baseline alignment, mJOA, EQ-5D, or NDI between groups. Patients who improved only in myelopathy showed significant differences in baseline-1Y EQ-5D (baseline: 0.74, 1 yr:0.83, P < 0.001). One-year C2-S1 sagittal vertical axis (SVA; mJOA r = -0.424, P = 0.002; EQ-5D r = -0.261, P = 0.050; NDI r = 0.321, P = 0.015) and C7-S1 SVA (mJOA r = -0.494, P < 0.001; EQ-5D r = -0.284, P = 0.031; NDI r = 0.334, P = 0.010) were correlated with improvement in health-related qualities of life.
After CD-corrective surgery, improvements in myelopathy symptoms and functional score were associated with superior 1-year patient-reported outcomes. Although there were no relationships between cervical-specific sagittal parameters and patient outcomes, global parameters of C2-S1 SVA and C7-S1 SVA showed significant correlations with overall 1-year mJOA, EQ-5D, and NDI. These results highlight myelopathy improvement as a key driver of patient-reported outcomes, and confirm the importance of sagittal alignment in patients with CD.
回顾性研究。
确定颈椎畸形（CD）矫正手术后，对线或脊髓病改善是否是患者预后的驱动因素。
CD 矫正包括放射对线矫正和改善运动功能和疼痛的手术。尚不清楚对线或脊髓病改善是否会影响患者预后。
纳入标准：基线/1 年有影像学和结果评分的 CD 患者。颈椎对线改善定义为 Ames CD 修正指数的改善。改良日本矫形协会（mJOA）改善定义为轻度[15-17]、中度[12-14]、重度[<12]。患者组包括仅对线改善、仅 mJOA 改善、同时改善和无改善的患者。评估各组间生活质量评分（颈部残疾指数[NDI]、EuroQuol-5 维度[EQ-5D]、mJOA）的变化。
共纳入 70 例患者（62 岁，51%为女性）。术前 mJOA 总分为 13.04±2.35。基线时，21 例（30%）患者有轻度脊髓病，33 例（47%）为中度，16 例（23%）为重度。70 例患者中，30 例（44%）mJOA 改善，13 例（18.6%）达到 1 年 mJOA 最小临床重要差异。改善组分布：16/70（23%）仅对线改善，13/70（19%）仅脊髓病改善，18/70（26%）对线和脊髓病改善，23/70（33%）无改善。16 例（69%）仅对线改善患者中有 11 例 EQ-5D 改善，18 例（61%）脊髓病/对线改善患者中有 11 例 EQ-5D 改善，13 例（100%）仅脊髓病改善患者中有 13 例 EQ-5D 改善，23 例（44%）无脊髓病/对线改善患者中有 10 例 EQ-5D 改善。各组间减压、基线对线、mJOA、EQ-5D 和 NDI 无差异。仅脊髓病改善的患者在基线-1 年 EQ-5D 方面有显著差异（基线：0.74，1 年：0.83，P<0.001）。1 年 C2-S1 矢状垂直轴（mJOA r=-0.424，P=0.002；EQ-5D r=-0.261，P=0.050；NDI r=-0.321，P=0.015）和 C7-S1 矢状垂直轴（mJOA r=-0.494，P<0.001；EQ-5D r=-0.284，P=0.031；NDI r=-0.334，P=0.010）与健康相关生活质量的改善相关。
CD 矫正手术后，脊髓病症状和功能评分的改善与 1 年患者报告的预后更好相关。尽管颈椎特定矢状参数与患者预后之间没有关系，但 C2-S1 矢状垂直轴和 C7-S1 矢状垂直轴的总体参数与整体 1 年 mJOA、EQ-5D 和 NDI 显著相关。这些结果强调了脊髓病改善是患者报告结果的关键驱动因素，并证实了矢状对线在 CD 患者中的重要性。
3。
