Department of Orthopedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China.
Department of Orthopedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China.
World Neurosurg. 2019 Oct;130:e915-e925. doi: 10.1016/j.wneu.2019.07.035. Epub 2019 Jul 10.
To evaluate the clinical and radiographic outcomes of an anterior-only approach for the correction of severe cervical kyphotic deformities.
We performed a retrospective study of 33 consecutive patients with severe cervical kyphosis treated with an anterior cervical operation and preoperative and intraoperative skull traction. Cobb angle, kyphosis index (KI), kyphosis level, C2-7 sagittal vertical axis (SVA), and T1 slope were measured. The preoperative and postoperative Japanese Orthopedic Association (JOA) scores, visual analog scale (VAS) score for neck pain, Neck Disability Index (NDI) scores, and cervical alignment were compared.
The mean angle of the kyphosis was 83.2 ± 20.4°. The mean Cobb angle of the operative region was 71.7 ± 18.5° preoperation, which was reduced to 10.6 ± 5.7° postoperation (mean correction, 85.2%). The mean KI was 75.1 ± 18.2 preoperation, which was reduced to 14.4 ± 9.1 postoperation (mean correction, 80.8%). The preoperative and postoperative mean C2-7 Cobb angle was 53.8 ± 16.5° and 14.7 ± 7.6°, respectively. The preoperative and postoperative mean C2-7 SVA was 3.9 ± 14.5 mm and 12.8 ± 7.3 mm, respectively. The preoperative and postoperative mean T1 slope was -9.4 ± 15.7° and 7.3 ± 13.1°, respectively. The average postoperative C2-7 Cobb angle, Cobb angle of the operative region, KI, C2-7 SVA, and T1 slope changed significantly compared with preoperative values (P < 0.05). The average postoperative JOA, VAS, and NDI scores improved significantly compared with preoperative scores (P < 0.05).
Preoperative and intraoperative skull traction combined with anterior-only cervical operation may be a safe and effective technique for treating severe cervical kyphosis. If the postoperative correction is >80%, sufficient decompression could be achieved.
评估前路手术治疗重度颈椎后凸畸形的临床和影像学结果。
我们对 33 例重度颈椎后凸畸形患者进行了回顾性研究，这些患者均接受了前路颈椎手术和术前及术中颅骨牵引治疗。测量 Cobb 角、后凸指数（KI）、后凸水平、C2-7 矢状垂直轴（SVA）和 T1 斜率。比较术前和术后日本矫形协会（JOA）评分、颈部疼痛视觉模拟评分（VAS）、颈残障指数（NDI）评分和颈椎排列。
后凸角度的平均角度为 83.2 ± 20.4°。手术区域的平均 Cobb 角术前为 71.7 ± 18.5°，术后为 10.6 ± 5.7°（平均矫正 85.2%）。平均 KI 术前为 75.1 ± 18.2，术后为 14.4 ± 9.1（平均矫正 80.8%）。术前和术后 C2-7 Cobb 角的平均值分别为 53.8 ± 16.5°和 14.7 ± 7.6°。术前和术后 C2-7 SVA 的平均值分别为 3.9 ± 14.5mm 和 12.8 ± 7.3mm。术前和术后 T1 斜率的平均值分别为-9.4 ± 15.7°和 7.3 ± 13.1°。与术前相比，术后 C2-7 Cobb 角、手术区域 Cobb 角、KI、C2-7 SVA 和 T1 斜率的平均值变化均有统计学意义（P < 0.05）。与术前相比，术后 JOA、VAS 和 NDI 评分的平均值均有显著改善（P < 0.05）。
术前和术中颅骨牵引联合前路颈椎手术可能是治疗重度颈椎后凸畸形的一种安全有效的方法。如果术后矫正>80%，则可以获得充分的减压。
