Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Sichuan, China.
Department of Operation Room, West China Hospital, Sichuan University, Sichuan, China.
J Orthop Surg (Hong Kong). 2020 Sep-Dec;28(3):2309499020968295. doi: 10.1177/2309499020968295.
Cervical sagittal balance plays important roles in transmitting the load of the head and maintaining global spinal balance. This study aimed to identify the association of cervical sagittal alignment with adjacent segment degeneration (ASD) and heterotopic ossification (HO) after Prestige-LP cervical disc replacement (CDR).
We enrolled 132 patients who underwent one-level Prestige-LP CDR with 2-10 years of follow-up. Cervical sagittal alignment parameters, including the degree of C2-C7 lordosis (CL), functional spinal unit angle (FSUA), sagittal vertical axis (SVA),, and T1 slope (T1s), were measured. ASD and HO were evaluated at the last follow-up. Unpaired tests and logistic regression analysis were used to identify the associations of cervical sagittal alignment with ASD and HO.
We found that patients who developed ASD showed significantly lower FSUA (2.1° vs. -1.4°, < 0.001) and T1s values (28.4° vs. 25.5°, = 0.029) after surgery. Similarly, the postoperative CL was significantly better in patients without ASD or HO (18.0° vs. 14.4°, = 0.043). The decrease in the T1s at the last follow-up was significantly larger in the patients with ASD (-11.0° vs. -3.2°, = 0.003), HO (-6.7° vs. -2.7°, = 0.050), and ASD or HO (-7.0° vs. -0.8°, < 0.001) than in those without ASD or HO. Multivariate logistic regression analysis showed that both the FSUA and T1s are associated with ASD and that the degree of CL is associated with postoperative complications.
The results imply that maintaining cervical sagittal alignment after Prestige-LP CDR is important.
颈椎矢状平衡在传递头部负荷和维持整体脊柱平衡方面起着重要作用。本研究旨在探讨颈椎曲度置换（CDR）后颈椎矢状位排列与邻近节段退变（ASD）和异位骨化（HO）的关系。
我们纳入了 132 例接受单节段 Prestige-LP CDR 治疗且随访时间为 2-10 年的患者。测量颈椎矢状位排列参数，包括 C2-C7 前凸角（CL）、功能单位角（FSUA）、矢状垂直轴（SVA）、T1 斜率（T1s）。末次随访时评估 ASD 和 HO。采用独立样本 t 检验和逻辑回归分析评估颈椎矢状位排列与 ASD 和 HO 的关系。
我们发现，发生 ASD 的患者术后 FSUA（2.1° vs. -1.4°， ＜0.001）和 T1s 值（28.4° vs. 25.5°， ＝0.029）明显更低。同样，无 ASD 或 HO 的患者术后 CL 更好（18.0° vs. 14.4°， ＝0.043）。ASD（-11.0° vs. -3.2°， ＝0.003）、HO（-6.7° vs. -2.7°， ＝0.050）和 ASD 或 HO 患者的 T1s 在末次随访时的下降明显大于无 ASD 或 HO 的患者。多变量逻辑回归分析表明，FSUA 和 T1s 均与 ASD 相关，CL 与术后并发症相关。
这些结果表明，维持 Prestige-LP CDR 后颈椎矢状位排列很重要。
