Kim Chang-Wook, Hyun Seung-Jae, Kim Ki-Jeong
Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
Neurospine. 2020 Sep;17(3):497-504. doi: 10.14245/ns.2040476.238. Epub 2020 Sep 30.
When spinal imbalance occurs, the human body reacts through various compensatory mechanisms to maintain the head over the pelvis and to retain a horizontal gaze. These compensations occur through mobile spine segments as well as pelvic tilt and lower extremities. The purpose of this review was to understand the surgical impact on global sagittal alignment and health-related quality of life (HRQoL) following cervical kyphosis correction surgery. The cervical kyphosis correction surgery induces reciprocal changes in craniocervical and thoracolumbar alignment. Successful cervical deformity correction needs to focus not only on restoring proper cervical lordosis, but also on achieving global balance of the cervical spine with other parts of the spine. The goal of the surgery is to achieve occiputtrunk (OT) concordance (the center of gravity-C7 sagittal vertical axis < 30 mm) and cervical sagittal balance. Once OT-concordance is achieved, subsequent thoracolumbar alignment changes occur as needed to harmonize global spinal alignment. Reciprocal changes after surgery exhibit different patterns depending on whether patients have compensation ability in their thoracolumbar spine or not. C2-7 sagittal vertical axis and sagittal morphotype of the cervical kyphosis are correlated with HRQoL. Changes in cervical lordosis minus T1 slope correlate to HRQoL improvements.
当脊柱失衡发生时，人体会通过各种代偿机制做出反应，以保持头部位于骨盆上方并维持水平视线。这些代偿通过可活动的脊柱节段以及骨盆倾斜和下肢来实现。本综述的目的是了解颈椎后凸矫正手术后对整体矢状位排列和健康相关生活质量（HRQoL）的手术影响。颈椎后凸矫正手术会引起颅颈和胸腰段排列的相互变化。成功的颈椎畸形矫正不仅需要关注恢复适当的颈椎前凸，还需要实现颈椎与脊柱其他部位的整体平衡。手术的目标是实现枕颈（OT）协调（重心-C7矢状垂直轴<30mm）和颈椎矢状平衡。一旦实现OT协调，随后胸腰段排列会根据需要发生变化，以协调整体脊柱排列。手术后的相互变化根据患者胸腰椎是否具有代偿能力而表现出不同的模式。颈椎后凸的C2-7矢状垂直轴和矢状形态类型与HRQoL相关。颈椎前凸减去T1斜率的变化与HRQoL的改善相关。
