Yeni Yener N, Baumer Timothy, Oravec Daniel, Basheer Azam, Bey Michael J, Bartol Stephen W, Chang Victor
Department of Orthopedic Surgery, Henry Ford Health System, Detroit, MI, USA.
Department of Neurosurgery, Henry Ford Health System, Detroit, MI, USA.
J Spine Surg. 2020 Mar;6(1):18-25. doi: 10.21037/jss.2020.03.02.
Post-surgical changes in adjacent segment motion are considered a factor in further development of degeneration and cervical radiculopathy. The objective was to examine the extent of correlations between physiological motion of cervical foramina and long-term patient reported outcomes (PRO).
Biplane X-ray imaging and CT-based markerless tracking were used to measure 3D static and dynamic dimensions during neck axial rotation and extension from 18 patients treated for C5-6 radiculopathy with fusion or arthroplasty. Minimum foraminal height (FH.Min) and width (FW.Min), and their range (FH.Range and FW.Range) achieved during a motion task were calculated for adjacent levels (C4-5 and C6-7) at 2.0±0.6 years post-surgery. The modified Japanese Orthopedic Association score (mJOAS), the Neck Disability Index (NDI) including the visual analogue scale (VAS) for neck and arm pain, and the EuroQol EQ-5D score were recorded at 6.5±1.1 years post-surgery. The relationships between 6.5-year outcomes and 2-year foraminal motion were examined using regression.
Worsening patient-reported outcomes were generally associated with lower values of FW.Min (P<0.05 to P<0.008), the associations being stronger for neck extension (r up to 0.43). Dynamic foraminal measurements from the C6-7 level more significantly and consistently correlated with mJOAS, EQ-5D and NDI Arm Pain VAS (r=0.27 to 0.43; P<0.03 to P<0.008), whereas those from the C4-5 level correlated with NDI Neck Pain VAS (r=0.33; P<0.02).
Dynamic 3D foraminal dimensions at 2-year post-surgery, notably FW.Min measured in neck extension at adjacent levels, were associated with PRO at 6.5 years post-surgery. These relationships provide insight into the motion related factors in development of pain and loss of function, and may help develop markers or objective outcome measures.
手术相邻节段活动度的改变被认为是退变和神经根型颈椎病进一步发展的一个因素。目的是研究颈椎椎间孔生理活动度与患者长期报告结局（PRO）之间的相关程度。
对18例接受C5-6神经根型颈椎病融合或置换手术的患者，采用双平面X线成像和基于CT的无标记跟踪技术，测量颈部轴向旋转和伸展时的三维静态和动态尺寸。计算术后2.0±0.6年相邻节段（C4-5和C6-7）在运动任务中达到的最小椎间孔高度（FH.Min）和宽度（FW.Min）及其范围（FH.Range和FW.Range）。记录术后6.5±1.1年的改良日本骨科学会评分（mJOAS）、包括颈部和手臂疼痛视觉模拟量表（VAS）的颈部功能障碍指数（NDI）以及欧洲五维度健康量表（EuroQol EQ-5D）评分。采用回归分析研究6.5年结局与2年椎间孔活动度之间的关系。
患者报告结局恶化通常与FW.Min值较低有关（P<0.05至P<0.008），颈部伸展时的相关性更强（r高达0.43）。C6-7节段的动态椎间孔测量值与mJOAS、EQ-5D和NDI手臂疼痛VAS的相关性更显著且一致（r=0.27至0.43；P<0.03至P<0.008），而C4-5节段的测量值与NDI颈部疼痛VAS相关（r=0.33；P<0.02）。
术后2年的动态三维椎间孔尺寸，尤其是相邻节段颈部伸展时测量的FW.Min，与术后6.5年的PRO相关。这些关系有助于深入了解疼痛和功能丧失发展过程中与运动相关的因素，并可能有助于开发标志物或客观结局指标。
