Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
Department of Anesthesia and Operation Center/West China School of Nursing, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
BMC Musculoskelet Disord. 2021 Jan 15;22(1):82. doi: 10.1186/s12891-021-03962-x.
Cervical disc replacement (CDR) has been widely used to treat one- and two-level cervical degenerative disc disease. Studies have shown the effectiveness of CDR in preserving range of motion (ROM) and delaying adjacent segment degeneration (ASD). Cervical sagittal alignment is an important factor affecting favorable clinical outcomes in cervical spine surgery. This study aimed to explore whether cervical sagittal alignment can be maintained after CDR and to identify the impact of cervical sagittal alignment on outcomes after CDR.
This was a single-center, retrospective study. 132 patients who underwent one-level CDR were included. Cervical sagittal alignments, including cervical lordosis (CL), segmental alignment (SA), sagittal vertical axis (SVA), T1 slope (T1s), and T1s minus CL (T1s-CL), were measured. The effects of cervical sagittal alignment on the CDR outcomes were analyzed. Patients were divided into the heterotopic ossification (HO) group and ASD group to determine the potential impacts of cervical sagittal parameters.
The cervical sagittal alignment parameters, except for the SVA, were significantly improved after CDR and showed decreasing trends at the last follow-up. Significantly higher CL and T1s were found in patients with better ROM after CDR. SVA ≥ 20 mm increased the risk of anterior HO (odds ratio = 2.945, P = 0.007). Significantly kyphotic SA and lower T1s values were found in the ASD patients than in the non-ASD patients (P < 0.05). Patients with ASD at the inferior level showed significantly worse CL (P < 0.05).
CDR had limited function of improving cervical sagittal alignment. Poor cervical sagittal alignment after CDR was associated with HO, ASD, and less ROM.
颈椎间盘置换术（CDR）已广泛用于治疗单节段和双节段颈椎退行性椎间盘疾病。研究表明，CDR 在保留活动度（ROM）和延缓邻近节段退变（ASD）方面具有有效性。颈椎矢状位排列是影响颈椎手术临床结果的重要因素。本研究旨在探讨 CDR 后颈椎矢状位排列是否能得到维持，并确定颈椎矢状位排列对 CDR 后结果的影响。
这是一项单中心、回顾性研究。共纳入 132 例接受单节段 CDR 的患者。测量颈椎矢状位排列，包括颈椎前凸（CL）、节段性排列（SA）、矢状垂直轴（SVA）、T1 斜率（T1s）和 T1s-CL。分析颈椎矢状位排列对 CDR 结果的影响。将患者分为异位骨化（HO）组和 ASD 组，以确定颈椎矢状位参数的潜在影响。
除 SVA 外，CDR 后颈椎矢状位排列参数均显著改善，末次随访时呈下降趋势。CDR 后 ROM 更好的患者 CL 和 T1s 显著更高。SVA≥20mm 增加了前侧 HO 的风险（比值比=2.945，P=0.007）。ASD 患者的 SA 明显更后凸，T1s 值更低（P<0.05）。下位 ASD 患者 CL 明显更差（P<0.05）。
CDR 对改善颈椎矢状位排列的功能有限。CDR 后颈椎矢状位排列不良与 HO、ASD 和 ROM 减少有关。
