Lee Bryan S, Walsh Kevin M, Lubelski Daniel, Knusel Konrad D, Steinmetz Michael P, Mroz Thomas E, Schlenk Richard P, Kalfas Iain H, Benzel Edward C
1Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, Ohio.
5Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, Ohio.
J Neurosurg Spine. 2018 Oct 12;30(1):38-45. doi: 10.3171/2018.6.SPINE1862. Print 2019 Jan 1.
OBJECTIVEComplete radiographic and clinical evaluations are essential in the surgical treatment of cervical spondylotic myelopathy (CSM). Prior studies have correlated cervical sagittal imbalance and kyphosis with disability and worse health-related quality of life. However, little is known about C2-3 disc angle and its correlation with postoperative outcomes. The present study is the first to consider C2-3 disc angle as an additional radiographic predictor of postoperative adverse events.METHODSA retrospective chart review was performed to identify patients with CSM who underwent surgeries from 2010 to 2014. Data collected included demographics, baseline presenting factors, and postoperative outcomes. Cervical sagittal alignment variables were measured using the preoperative and postoperative radiographs. Univariable logistic regression analyses were used to explore the association between dependent and independent variables, and a multivariable logistic regression model was created using stepwise variable selection.RESULTSThe authors identified 171 patients who had complete preoperative and postoperative radiographic and outcomes data. The overall rate of postoperative adverse events was 33% (57/171), and postoperative C2-3 disc angle, C2-7 sagittal vertical axis, and C2-7 Cobb angle were found to be significantly associated with adverse events. Inclusion of postoperative C2-3 disc angle in the analysis led to the best prediction of adverse events. The mean postoperative C2-3 disc angle for patients with any postoperative adverse event was 32.3° ± 17.2°, and the mean for those without any adverse event was 22.4° ± 11.1° (p < 0.0001).CONCLUSIONSIn the present retrospective analysis of postoperative adverse events in patients with CSM, the authors found a significant association between C2-3 disc angle and postoperative adverse events. They propose that C2-3 disc angle be used as an additional parameter of cervical spinal sagittal alignment and predictor for operative outcomes.
目的
完整的影像学和临床评估对于脊髓型颈椎病（CSM）的手术治疗至关重要。先前的研究已将颈椎矢状面失衡和后凸畸形与残疾及较差的健康相关生活质量联系起来。然而，关于C2-3椎间盘角度及其与术后结果的相关性却知之甚少。本研究首次将C2-3椎间盘角度视为术后不良事件的一项额外影像学预测指标。
方法
进行一项回顾性病历审查，以确定2010年至2014年接受手术的CSM患者。收集的数据包括人口统计学资料、基线呈现因素和术后结果。使用术前和术后的X线片测量颈椎矢状面排列变量。采用单变量逻辑回归分析来探讨因变量和自变量之间的关联，并使用逐步变量选择创建多变量逻辑回归模型。
结果
作者确定了171例术前和术后有完整影像学及结果数据的患者。术后不良事件的总体发生率为33%（57/171），发现术后C2-3椎间盘角度、C2-7矢状垂直轴和C2-7 Cobb角与不良事件显著相关。在分析中纳入术后C2-3椎间盘角度可对不良事件进行最佳预测。发生任何术后不良事件的患者术后C2-3椎间盘角度的平均值为32.3°±17.2°，未发生任何不良事件的患者的平均值为22.4°±11.1°（p<0.0001）。
结论
在本项对CSM患者术后不良事件的回顾性分析中，作者发现C2-3椎间盘角度与术后不良事件之间存在显著关联。他们建议将C2-3椎间盘角度用作颈椎矢状面排列的一项额外参数以及手术结果的预测指标。
