Departments of Orthopedic and Neurologic Surgery, NYU Langone Orthopedic Hospital; New York Spine Institute, New York, NY.
Department of Orthopedics, Hospital for Special Surgery, New York, NY.
Spine (Phila Pa 1976). 2021 May 1;46(9):559-566. doi: 10.1097/BRS.0000000000003971.
Retrospective review of a prospective database.
The aim of this study was to identify demographic, surgical, and radiographic factors that predict superior recovery kinetics following cervical deformity (CD) corrective surgery.
Analyses of CD corrective surgery use area under the curve (AUC) to assess health-related quality of life (HRQL) metrics throughout recovery.
Outcome measures were baseline (BL) to 1-year (1Y) health-related quality of life (HRQL) (Neck Disability Index [NDI]). CD criteria were C2-7 Cobb angle >10°, coronal Cobb angle >10°, C2-C7 sagittal vertical axis (cSVA) >4 cm, TS-CL >10°, or chin-brow vertical angle >25°. AUC normalization divided BL and postoperative outcomes by BL. Normalized scores (y axis) were plotted against follow-up (x axis). AUC was calculated and divided by cumulative follow-up length to determine overall, time-adjusted recovery (Integrated Health State [IHS]). IHS NDI was stratified by quartile, uppermost 25% being "Superior" Recovery Kinetics (SRK) versus "Normal" Recovery Kinetics (NRK). BL demographic, clinical, and surgical information predicted SRK using generalized linear modeling.
Ninety-eight patients included (62 ± 10 years, 28 ± 6 kg/m2, 65% females, Charlson Comorbidity Index: 0.95), 6% smokers, 31% smoking history. Surgical approach was: combined (33%), posterior (49%), anterior (18%). Posterior levels fused: 8.7, anterior: 3.6, estimated blood loss: 915.9ccs, operative time: 495 minutes. Ames BL classification: cSVA (53.2% minor deformity, 46.8% moderate), TS-CL (9.8% minor, 4.3% moderate, 85.9% marked), horizontal gaze (27.4% minor, 46.6% moderate, 26% marked). Relative to BL NDI (Mean: 47), normalized NDI decreased at 3 months (0.9 ± 0.5, P = 0.260) and 1Y (0.78 ± 0.41, P < 0.001). NDI IHS correlated with age (P = 0.011), sex (P = 0.042), anterior approach (P = 0.042), posterior approach (P = 0.042). Greater BL pelvic tilt (PT) (SRK: 25.6°, NRK: 17°, P = 0.002), pelvic incidence-lumbar lordosis (PI-LL) (SRK: 8.4°, NRK: -2.8°, P = 0.009), and anterior approach (SRK: 34.8%, NRK: 13.3%; P = 0.020) correlated with SRK. 69.4% met MCID for NDI (<Δ-15) and 63.3% met substantial clinical benefit for NDI (<Δ-10); 100% of SRK met both MCID and substantial clinical benefit. The predictive model for SRK included (AUC = 88.1%): BL visual analog scale (VAS) EuroQol five-dimensional descriptive system (EQ5D) (odds rario [OR] 0.96, 95% confidence interval [CI]: 0.92-0.99), BL swallow sleep score (OR: 1.04, 95% CI: 1.01-1.06), BL PT (OR: 1.12, 95% CI: 1.03-1.22), BL modified Japanese Orthopedic Association scale (mJOA) (OR: 1.5, 95% CI: 1.07-2.16), BL T4-T12, BL T10-L2, BL T12-S1, and BL L1-S1.
Superior recovery kinetics following CD surgery was predicted with high accuracy using BL patient-reported (VAS EQ5D, swallow sleep, mJOA) and radiographic factors (PT, TK, T10-L2, T12-S1, L1-S1). Awareness of these factors can improve decision-making and reduce postoperative neck disability.Level of Evidence: 3.
前瞻性数据库的回顾性研究。
本研究旨在确定预测颈椎畸形（CD）矫正手术后恢复动力学的人口统计学、手术和影像学因素。
CD 矫正手术的分析使用曲线下面积（AUC）来评估整个恢复期的健康相关生活质量（HRQL）指标。
结局指标为基线（BL）至 1 年（1Y）的健康相关生活质量（HRQL）（颈椎障碍指数[NDI]）。CD 标准为 C2-7 Cobb 角>10°，冠状 Cobb 角>10°，C2-C7 矢状垂直轴（cSVA）>4cm，TS-CL>10°或颏眉垂直角>25°。BL 和术后结果通过 BL 进行归一化。归一化分数（y 轴）与随访（x 轴）相对应。计算 AUC 并除以累积随访长度以确定总体、时间调整后的恢复（综合健康状况[IHS]）。IHS NDI 根据四分位数分层，最高 25%为“卓越”恢复动力学（SRK）与“正常”恢复动力学（NRK）。使用广义线性建模预测 BL 人口统计学、临床和手术信息的 SRK。
纳入 98 例患者（62±10 岁，28±6kg/m2，65%女性，Charlson 合并症指数：0.95），6%为吸烟者，31%有吸烟史。手术方法为：联合（33%）、后（49%）、前（18%）。后路融合节段：8.7，前路：3.6，估计失血量：915.9ccs，手术时间：495 分钟。Ames BL 分类：cSVA（53.2%轻度畸形，46.8%中度），TS-CL（9.8%轻度，4.3%中度，85.9%明显），水平凝视（27.4%轻度，46.6%中度，26%明显）。相对于 BL NDI（均值：47），3 个月时的归一化 NDI 降低（0.9±0.5，P=0.260），1 年时降低（0.78±0.41，P<0.001）。NDI IHS 与年龄（P=0.011）、性别（P=0.042）、前路方法（P=0.042）、后路方法（P=0.042）相关。更大的 BL 骨盆倾斜度（PT）（SRK：25.6°，NRK：17°，P=0.002）、骨盆入射角-腰椎前凸（PI-LL）（SRK：8.4°，NRK：-2.8°，P=0.009）和前路方法（SRK：34.8%，NRK：13.3%；P=0.020）与 SRK 相关。69.4%的患者 NDI 达到了<Δ-15 的 MCID，63.3%的患者 NDI 达到了<Δ-10 的显著临床获益；100%的 SRK 同时满足 MCID 和显著临床获益。SRK 的预测模型包括（AUC=88.1%）：BL 视觉模拟量表（VAS）EuroQol 五维描述性系统（EQ5D）（优势比[OR]0.96，95%置信区间[CI]：0.92-0.99），BL 吞咽睡眠评分（OR：1.04，95%CI：1.01-1.06），BL PT（OR：1.12，95%CI：1.03-1.22），BL 改良日本矫形协会评分（mJOA）（OR：1.5，95%CI：1.07-2.16），BL T4-T12，BL T10-L2，BL T12-S1，BL L1-S1。
使用 BL 患者报告（VAS EQ5D、吞咽睡眠、mJOA）和影像学因素（PT、TK、T10-L2、T12-S1、L1-S1）可以高度准确地预测 CD 手术后卓越的恢复动力学。了解这些因素可以改善决策制定并减少术后颈部残疾。
3。
