在多节段颈椎后路手术中，用于预防矢状面失衡的合适远端融合节段是C7还是T1？
What is a Right Distal Fusion Level for Prevention of Sagittal Imbalance in Multilevel Posterior Cervical Spine Surgery: C7 or T1?
作者信息
Choi Seung-Jin, Suk Kyung-Soo, Yang Jae-Ho, Kim Hak-Sun, Lee Hwan-Mo, Moon Seong-Hwan, Lee Byung-Ho, Park Sang-Jun
机构信息
Department of Orthopedic Surgery, Kwandong University College of Medicine, Incheon.
Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea.
出版信息
Clin Spine Surg. 2018 Dec;31(10):441-445. doi: 10.1097/BSD.0000000000000725.
STUDY DESIGN
This was a retrospective cohort study.
OBJECTIVE
To evaluate the sagittal alignment and T1 slope after multilevel posterior cervical fusion surgery depending on the distal fusion level; C7 or T1, and find out the appropriate distal fusion level.
SUMMARY OF BACKGROUND DATA
The sagittal balance of the cervical spine is known to be affected by cervical lordosis and T1 slope. However, T1 slope is not a constant parameter that can be frequently changed after the surgery. Furthermore, useful studies to help guide surgeons in decision-making as to the most appropriate distal level of fusion for cervical sagittal balance are very limited.
MATERIALS AND METHODS
From 2014 to 2015, 50 patients who underwent multilevel posterior cervical fusion surgery were evaluated and followed up for >2 years. Group 1 was composed of 29 patients whose distal fusion level was C7. Group 2 was composed of 21 patients whose distal fusion level was T1. C1-C2 lordosis, C2-C7 lordosis, C2-C7 sagittal vertical axis (SVA), and T1 slope were measured on preoperative and the last follow-up.
RESULTS
In group 1, C2-C7 SVA (23.1→30.4 mm, P=0.043) was worsened, and T1 slope (22.3→32.9 degrees, P=0.001) was increased after the surgery. In group 2, no significant change occurred in C2-C7 SVA after the surgery (25.3 →23.6 mm, P=0.648). The last follow-up T1 slope was similar with preoperative T1 slope (22.7→21.8 degrees, P=0.04) in group 2.
CONCLUSIONS
This study showed that sagittal alignment became worse after the multilevel posterior cervical surgery when distal fusion level was stopped at C7, which was associated with increase of T1 slope. However, when we extended the distal fusion level to T1, T1 slope was not changed after the surgery. Therefore, sagittal alignment was maintained after the surgery. On the basis of the results of this study, we recommend distal fusion extends to T1.
LEVEL OF EVIDENCE
Level III.
研究设计
这是一项回顾性队列研究。
目的
根据远端融合节段（C7或T1）评估多节段颈椎后路融合术后的矢状面排列和T1斜率，并找出合适的远端融合节段。
背景资料总结
已知颈椎的矢状面平衡受颈椎前凸和T1斜率影响。然而，T1斜率并非一个恒定参数，术后可能会频繁改变。此外，有助于指导外科医生就颈椎矢状面平衡选择最合适远端融合节段进行决策的有用研究非常有限。
材料与方法
2014年至2015年，对50例行多节段颈椎后路融合术的患者进行评估并随访超过2年。第1组由29例远端融合节段为C7的患者组成。第2组由21例远端融合节段为T1的患者组成。在术前和末次随访时测量C1-C2前凸、C2-C7前凸、C2-C7矢状垂直轴（SVA）和T1斜率。
结果
在第1组中，术后C2-C7 SVA（23.1→30.4 mm，P = 0.043）恶化，T1斜率（22.3→32.9度，P = 0.001）增加。在第2组中，术后C2-C7 SVA无显著变化（25.3→23.6 mm，P = 0.648）。第2组末次随访时的T1斜率与术前T1斜率相似（22.7→21.8度，P = 0.04）。
结论
本研究表明，当多节段颈椎后路手术的远端融合节段止于C7时，矢状面排列术后变差，这与T1斜率增加有关。然而，当我们将远端融合节段延长至T1时，术后T1斜率未改变。因此，术后矢状面排列得以维持。基于本研究结果，我们建议远端融合延伸至T1。
证据级别
III级。
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