Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY.
Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Spine (Phila Pa 1976). 2019 Aug 1;44(15):1049-1056. doi: 10.1097/BRS.0000000000003007.
Retrospective cross-sectional cohort.
To investigate the prevalence and predictive factors of concurrent cervical spinal cord compression (CSCC) in patients with adult spinal deformity (ASD).
In patients with ASD undergoing major thoracolumbar realignment surgery, concurrent CSCC potentially increases the risk of progression of myelopathy or cervical cord injury due to various perioperative factors including poor intraoperative neck positioning and hypotension. However, the prevalence of CSCC in ASD patients has not been previously studied.
This study included ASD patients who were indicated for major thoracolumbar corrective surgery (>5 levels). The presence of CSCC was determined using the modified Cord Compression Index (Grades 0-3) based on the cervical magnetic resonance imaging (MRI). Significant CSCC was defined as Grade>2, and the distribution of compression level as well as the number of Grade>2 segments were investigated in each patient. A multivariate regression analysis was performed to identify the predictors of CSCC with variables being the patients' characteristics including radiographic sagittal alignment parameters.
Of 121 patients with ASD, 41 patients (33.8%) demonstrated significant CSCC on MRI. Intramedullary T2 hyper-intensity (myelomalacia) was present in eight patients (6.6%). Thirty-five of 41 patients were asymptomatic or with myelopathy that is difficult to detect. Significant CSCC was most commonly observed at C4/5 level. Four patients (3.3%) underwent cervical decompression and fusion prior to thoracolumbar reconstruction. Multivariate regression analysis revealed old age, increased body mass index (BMI), and PI-LL mismatch independently predicted the CSCC grade.
The prevalence of concurrent significant cervical cord compression in patients with ASD is relatively high at 33.8%. Preoperative evaluation of cervical MRI and examinations for signs/symptoms of myelopathy are essential for patients with (1) older age, (2) increased BMI, and (3) high PI-LL mismatch to avoid progressive myelopathy or cord injury during ASD surgery.
回顾性队列研究。
探讨成人脊柱畸形（ASD）患者并发颈椎脊髓压迫（CSCC）的患病率和预测因素。
在接受胸腰椎大复位手术的 ASD 患者中，由于术中颈部位置不佳和低血压等多种围手术期因素，并发 CSCC 可能会增加进展性脊髓病或颈髓损伤的风险。然而，ASD 患者中 CSCC 的患病率尚未得到研究。
本研究纳入了需要进行大胸腰椎矫正手术的 ASD 患者（>5 个节段）。使用改良 Cord Compression Index（分级 0-3）根据颈椎磁共振成像（MRI）确定 CSCC 的存在。显著 CSCC 定义为分级>2，在每位患者中均对压迫水平的分布和分级>2 节段的数量进行了研究。采用多变量回归分析确定 CSCC 的预测因素，变量为患者特征，包括影像学矢状面排列参数。
在 121 例 ASD 患者中，41 例（33.8%）MRI 显示存在显著 CSCC。8 例（6.6%）存在脊髓内 T2 高信号（脊髓软化）。35 例患者无症状或有难以察觉的脊髓病。在 C4/5 水平最常见显著 CSCC。在胸腰椎重建前，4 例（3.3%）患者行颈椎减压融合术。多变量回归分析显示，年龄较大、体重指数（BMI）增加和 PI-LL 不匹配是 CSCC 分级的独立预测因素。
ASD 患者并发显著颈椎脊髓压迫的患病率相对较高，为 33.8%。对于（1）年龄较大、（2）BMI 增加和（3）PI-LL 不匹配较高的患者，术前评估颈椎 MRI 并进行脊髓病的体征/症状检查对于避免 ASD 手术期间进展性脊髓病或脊髓损伤至关重要。
4 级。
