Löfgren Håkan, Osman Aras, Blomqvist Anders, Vavruch Ludek
Neuroorthopedic Center and Department of Radiology, Jönköping, Region Jönköping County, Sweden.
Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
Global Spine J. 2020 Jun;10(4):425-432. doi: 10.1177/2192568219858302. Epub 2019 Jun 26.
The aims of this study were to evaluate the incidence of sagittal malalignment including kyphosis following cervical laminectomy without fusion as treatment for cervical spondylotic myelopathy and to assess any correlation between malalignment and clinical outcome.
Retrospective cohort study.
In all, 60 patients were followed up with conventional radiography at an average of 8 years postoperatively. The cervical lordosis (C2-C7 Cobb angle), C2-C7 sagittal vertical axis (cSVA) and C7 slope were measured on both preoperative and postoperative images. Patients completed a questionnaire covering Neck Disability Index (NDI), visual analogue scale for neck pain, and general health (EQ-5D).
Mean C2-C7 Cobb angle was 8.6° (SD 9.0) preoperatively, 3.4° (10.7) postoperatively and 9.6° (14.5) at follow-up. Ultimately, 3 patients showed >20° cervical kyphosis. Mean cSVA was 16.3 mm (SD 10.2) preoperatively, 20.6 mm (11.8) postoperatively, and 31.6 mm (11.8) at follow-up. Mean C7 slope was 20.4° (SD 8.9) preoperatively, 18.4° (9.4) postoperatively, and 32.6° (10.2) at follow-up. The preoperative to follow-up increase in cSVA and C7 slope was statistically significant (both < .0001), but not for cervical lordosis. The preoperative to follow-up change in cSVA correlated moderately with preoperative cSVA ( = 0.43, = .002), as did the corresponding findings regarding C7 slope ( = 0.52, = .0001). A comparison of radiographic measurements with clinical outcome showed no strong correlations.
No preoperative to follow-up change in cervical lordosis was found in this group; 5.0% developed >20° kyphosis. No clear correlation between sagittal alignment and clinical outcome was shown.
本研究旨在评估未行融合术的颈椎椎板切除术治疗脊髓型颈椎病后矢状面排列不齐（包括后凸畸形）的发生率，并评估排列不齐与临床疗效之间的相关性。
回顾性队列研究。
总共60例患者在术后平均8年时接受了常规X线检查。在术前和术后影像上测量颈椎前凸（C2-C7 Cobb角）、C2-C7矢状垂直轴（cSVA）和C7斜率。患者完成了一份涵盖颈部功能障碍指数（NDI）、颈部疼痛视觉模拟量表和总体健康状况（EQ-5D）的问卷。
术前C2-C7 Cobb角平均为8.6°（标准差9.0），术后为3.4°（10.7），随访时为9.6°（14.5）。最终，3例患者出现>20°的颈椎后凸畸形。术前cSVA平均为16.3 mm（标准差10.2），术后为20.6 mm（11.8），随访时为31.6 mm（11.8）。术前C7斜率平均为20.4°（标准差8.9），术后为18.4°（9.4），随访时为32.6°（10.2）。cSVA和C7斜率从术前到随访时的增加具有统计学意义（均P <.0001），但颈椎前凸无统计学意义。cSVA从术前到随访时的变化与术前cSVA中度相关（r = 0.43，P = .002），C7斜率的相应结果也如此（r = 0.52，P = .0001）。影像学测量结果与临床疗效的比较未显示出强相关性。
该组患者颈椎前凸从术前到随访时无变化；5.0%的患者出现>20°的后凸畸形。矢状面排列与临床疗效之间未显示出明确的相关性。
