Spine Research Laboratory, Hospital for Special Surgery, New York, New York, USA.
Washington University School of Medicine, St. Louis, Missouri, USA.
World Neurosurg. 2020 Jul;139:e541-e547. doi: 10.1016/j.wneu.2020.04.057. Epub 2020 Apr 25.
Our aim was to define a treatment strategy for patients with severe cervical deformity (sCD).
Surgical patients with sCD were isolated based on preoperative radiographic parameters. We sent 10 sCD cases to 7 surgeons to find consensus on approach, upper instrumented vertebrae (UIVs), lower instrumented vertebrae (LIVs), and osteotomy. We performed a descriptive analysis and created a treatment algorithm from the survey and then analyzed a database of surgical patients to find the frequency of following our algorithm.
We found consensus on 7 cases for a posterior approach because of cervicothoracic deformity. Of 15 patients within our sCD database that had cervicothoracic deformity, 13 had a posterior approach. There was consensus on 2 cases for an anteroposterior approach because of local kyphosis. Of 25 patients that had local kyphosis, 18 had an anterior approach. In 4 cases, there was consensus of UIV of C2. Of 35 cases that had posterior fusion more than 6 levels, 20 had UIV of C2. In 3 cases, there was consensus of LIV below a previously fused spine. Of 36 patients that had a fusion of T6 or higher, 34 had LIV below the previous UIV. In 6 cases, there was consensus against an osteotomy because of cervical spine flexibility. Nine of 12 patients that had an osteotomy in our database had no flexibility on dynamic radiographs.
We outline an algorithm for deciding approach, UIV, LIV, and whether to do an osteotomy for patients with sCD based on consensus recommendations among spine surgeons.
我们旨在为严重颈椎畸形（sCD）患者制定治疗策略。
根据术前影像学参数，对患有 sCD 的手术患者进行了分离。我们将 10 例 sCD 病例发送给 7 位外科医生，以就方法、上器械椎（UIV）、下器械椎（LIV）和截骨术达成共识。我们进行了描述性分析，并根据调查结果创建了治疗算法，然后分析了手术患者的数据库，以找出遵循我们算法的频率。
我们在 7 例因颈胸段畸形而采用后路方法的病例中达成了共识。在我们 sCD 数据库中，13 例患有颈胸段畸形的患者中有 13 例采用后路方法。由于局部后凸，有 2 例病例采用前后路联合方法达成共识。在 25 例有局部后凸的患者中，18 例采用前路方法。在 4 例病例中，UIV 为 C2 达成共识。在 35 例后路融合超过 6 个节段的病例中，20 例 UIV 为 C2。在 3 例病例中，在先前融合的脊柱以下达成了 LIV 的共识。在 36 例 T6 或更高水平融合的患者中，34 例 LIV 在先前的 UIV 以下。在 6 例病例中，由于颈椎灵活性，共识反对进行截骨术。在我们数据库中接受截骨术的 12 例患者中有 9 例在动态 X 光片上没有灵活性。
我们根据脊柱外科医生之间的共识建议，为患有 sCD 的患者制定了决定治疗方法、UIV、LIV 以及是否进行截骨术的算法。
