Kim Han Jo, Choi Byung-Wan, Park JeaSeok, Pesenti Sebastien, Lafage Virginie
Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA.
Department of Orthopedic Surgery, Inje University, Haeundae Paik Hospital, 1435, Jwa-dong, Haeundae-gu, Busan, 612-030, Republic of Korea.
Eur J Orthop Surg Traumatol. 2019 May;29(4):767-774. doi: 10.1007/s00590-019-02386-7. Epub 2019 Jan 25.
OBJECTIVE: The purpose of this study was to evaluate its effect on the restoration and maintenance of cervical sagittal alignment in usual cervical degenerative diseases without preoperative sagittal malalignment. MATERIALS AND METHODS: We retrospectively evaluated 108 patients who were diagnosed with degenerative cervical disease and underwent ACDF (allograft and plating) with > 1-year follow-up. For radiographic evaluation, we analysed segmental and C2-7 cervical lordosis, disc height, C2-7 sagittal vertical axis (SVA), T1 slope, and T1 slope minus C2-7 lordosis (T1S - CL) in lateral X-ray. Clinical assessment was based on arm VAS, neck VAS, and NDI scores. Correlation analysis was performed across the pre-post-changes in radiological parameters. Correlations between the changes in radiological and clinical parameters at final follow-up were also analysed. RESULTS: C2-7 lordosis was 7.13° preoperatively and increased to 13.06° (p < 0.001) and maintained at 10.08° at final follow-up (p = 0.007). Segmental lordosis increased from 0.66° to 8.33° and maintained at 5.19° (p < 0.001). Segmental disc height was 4.67 mm preoperatively (increased to 7.13 mm postoperatively and decreased to 5.74 mm at final follow-up) (p < 0.001). SVA distance (31.53 mm to 30.02 mm) (p = 0.750) and T1 slope (30.03° to 31.37°) did not show meaningful change after surgery. Increase in segmental lordosis was correlated to an increase in C2-7 lordosis (p < 0.001). C2-7 SVA change correlated with both the T1 slope change (p < 0.001) and T1S - CL (p = 0.012). Change in SVA was correlated to a change in segmental lordosis and T1 slope (p = 0.003, p = 0.014). Clinical outcomes did not correlate with radiological findings. CONCLUSION: ACDF for the treatment of degenerative cervical disease without preoperative deformity was effective in restoring cervical sagittal alignment. Improvement of segmental lordosis related to an improvement in C2-7 lordosis and SVA. Radiological sagittal alignment did not show any relation with clinical outcomes in usual degenerative cases.
目的：本研究旨在评估其对无术前矢状面畸形的常见颈椎退行性疾病患者颈椎矢状面排列恢复及维持的影响。 材料与方法：我们回顾性评估了108例被诊断为颈椎退行性疾病并接受前路颈椎间盘切除融合术（同种异体骨移植和钢板固定）且随访时间超过1年的患者。对于影像学评估，我们在侧位X线片上分析节段性及C2 - 7颈椎前凸、椎间盘高度、C2 - 7矢状垂直轴（SVA）、T1斜率以及T1斜率减去C2 - 7前凸（T1S - CL）。临床评估基于手臂视觉模拟评分（VAS）、颈部VAS和颈椎功能障碍指数（NDI）评分。对放射学参数术前术后的变化进行相关性分析。还分析了末次随访时放射学参数变化与临床参数变化之间的相关性。 结果：C2 - 7颈椎前凸术前为7.13°，术后增加至13.06°（p < 0.001），末次随访时维持在10.08°（p = 0.007）。节段性前凸从0.66°增加至8.33°，并维持在5.19°（p < 0.001）。节段性椎间盘高度术前为4.67mm（术后增加至7.13mm，末次随访时降至5.74mm）（p < 0.001）。SVA距离（从31.53mm至30.02mm）（p = 0.750）和T1斜率（从30.03°至31.37°）术后未显示有意义的变化。节段性前凸的增加与C2 - 7颈椎前凸的增加相关（p < 0.001）。C2 - 7 SVA变化与T1斜率变化（p < 0.001）和T1S - CL（p = 0.012）均相关。SVA的变化与节段性前凸和T1斜率的变化相关（p = 0.003，p = 0.014）。临床结果与放射学表现无关。 结论：对于无术前畸形的颈椎退行性疾病，前路颈椎间盘切除融合术在恢复颈椎矢状面排列方面是有效的。节段性前凸的改善与C2 - 7颈椎前凸和SVA的改善相关。在常见的退行性病例中，放射学矢状面排列与临床结果无任何关联。
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