Tundo Frederico, Avila Mauricio J, Willard Laura, Fanous Sandra, Curri Cloe, Hussain Ibrahim, Baaj Ali A
Department of Orthopaedic and Locomotor Diseases, Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy.
Division of Neurosurgery, University of Arizona, Tucson, AZ, USA.
Clin Neurol Neurosurg. 2019 Oct;185:105496. doi: 10.1016/j.clineuro.2019.105496. Epub 2019 Aug 18.
Compared to the thoracolumbar spine, the literature on cervical spine alignment is scarce. While a consistent number of articles have been published, few analyze the ideal surgical approaches for each type of deformity and the optimal amount of correction to achieve. This paper provides a comprehensive review of current literature on cervical spinal deformities (with or without myelopathy) and their surgical management; it is our goal to create a framework on which surgical planning can be made. A general assessment of the actually utilized parameters and correlation between the cervical and thoracolumbar spine alignment is presented. Moreover, we provide an analysis of cervical surgical approaches (anterior, posterior, or combined), techniques (laminoplasty, laminectomy and fusion, anterior cervical discectomy and fusion, corpectomy), and their indications. Finally, a complete evaluation of outcomes and postoperative health-related quality of life (HRQOL) measures based on questionnaires (NDI, VAS, SF-36, mJOA) is discussed. Several prospective studies would be useful in understanding how cervical alignment may be important in the assessment and treatment of cervical deformities with or without myelopathy. In particular, future works should concentrate on the correlation between cervical alignment parameters, disability scores, and myelopathy outcomes. We propose, via comprehensive literature review, a guide of practical key points on surgical techniques, cervical alignment, and symptom improvement goals surgeons should aim to achieve for each patient.
与胸腰椎相比，关于颈椎排列的文献较少。虽然已经发表了一定数量的文章，但很少有文章分析每种畸形类型的理想手术方法以及要实现的最佳矫正量。本文对当前有关颈椎畸形（伴或不伴脊髓病）及其手术治疗的文献进行了全面综述；我们的目标是创建一个可用于制定手术计划的框架。文中还对实际使用的参数以及颈椎与胸腰椎排列之间的相关性进行了总体评估。此外，我们分析了颈椎手术方法（前路、后路或联合手术）、技术（椎板成形术、椎板切除及融合术、颈椎前路椎间盘切除及融合术、椎体次全切除术）及其适应证。最后，讨论了基于问卷（NDI、VAS、SF - 36、mJOA）对手术结果及术后健康相关生活质量（HRQOL）指标的全面评估。一些前瞻性研究将有助于理解颈椎排列在评估和治疗伴或不伴脊髓病的颈椎畸形中可能有多重要。特别是，未来的研究应集中在颈椎排列参数、残疾评分和脊髓病结果之间的相关性上。通过全面的文献综述，我们提出了一份关于手术技术、颈椎排列以及外科医生应为每位患者实现的症状改善目标的实用关键点指南。
