Hung Che-Wei, Wu Ming-Fang, Yu Gwo-Fane, Ko Chin-Chu, Kao Cheng-Hsing
Department of Spinal Surgery, Jhong Jheng Spine & Orthopedic Hospital, Kaohsiung City, Taiwan, ROC.
Department of Orthopedics, Jhong Jheng Spine & Orthopedic Hospital, Kaohsiung City, Taiwan, ROC.
Clin Neurol Neurosurg. 2018 May;168:140-146. doi: 10.1016/j.clineuro.2018.03.003. Epub 2018 Mar 9.
To analyze sagittal balance of the cervical spine after three operative methods for three consecutive levels.
A retrospective case selection and observational study was performed from December 2012 to December 2015: 20 patients underwent anterior cervical discectomy and fusion, 22 patients underwent hybrid surgery (HS), and 20 patients underwent total disc replacement (TDR). Perioperative parameters, clinical outcomes, and preoperative and postoperative sagittal parameters were recorded.
Clinical outcomes improved. Fusion and hybrid groups were associated with more postoperative focal lordosis than the TDR group (no significant difference). The postoperative C2-7 sagittal vertical axis (SVA) was greater in the TDR group (no significant difference). In the fusion group, the postoperative C2-7 SVA was highly correlated with the preoperative C2-7 SVA and postoperative C7 slope (C7SL). Postoperative C2-7 lordosis (C2-7L) was highly correlated with the preoperative C2-7 SVA and preoperative and postoperative C7SL. In the hybrid group, postoperative C2-7L was highly correlated with preoperative C2-7L, preoperative and postoperative focal lordosis, and C7SL. In the TDR group, the postoperative C2-7 SVA was highly correlated with the preoperative C2-7 SVA and postoperative C7 slope. The postoperative C2-7 SVA was also negatively correlated with postoperative C2-7L and focal lordosis. Postoperative C2-7L was highly correlated with postoperative focal lordosis.
For three or more levels of cervical degenerative disease, good clinical outcomes can be achieved. TDR may not be a good choice for large preoperative C2-7 SVA. HS provides good cervical range of motion and restores cervical lordosis and C2-7 SVA.
分析三种连续三个节段手术方法术后颈椎矢状面平衡情况。
对2012年12月至2015年12月进行回顾性病例选择和观察性研究：20例患者接受了颈椎前路椎间盘切除融合术，22例患者接受了混合手术（HS），20例患者接受了全椎间盘置换术（TDR）。记录围手术期参数、临床结果以及术前和术后矢状面参数。
临床结果得到改善。融合组和混合组术后局部前凸比TDR组更多（无显著差异）。TDR组术后C2-7矢状垂直轴（SVA）更大（无显著差异）。在融合组中，术后C2-7 SVA与术前C2-7 SVA和术后C7斜率（C7SL）高度相关。术后C2-7前凸（C2-7L）与术前C2-7 SVA以及术前和术后C7SL高度相关。在混合组中，术后C2-7L与术前C2-7L、术前和术后局部前凸以及C7SL高度相关。在TDR组中，术后C2-7 SVA与术前C2-7 SVA和术后C7斜率高度相关。术后C2-7 SVA也与术后C2-7L和局部前凸呈负相关。术后C2-7L与术后局部前凸高度相关。
对于三个或更多节段的颈椎退行性疾病，可取得良好的临床结果。对于术前C2-7 SVA较大的患者，TDR可能不是一个好选择。HS提供了良好的颈椎活动范围，并恢复了颈椎前凸和C2-7 SVA。
