Kim Han Jo, Yao Yu-Cheng, Bannwarth Mathieu, Smith Justin S, Klineberg Eric O, Mundis Gregory M, Protopsaltis Themistocles S, Charles-Elysee Jonathan, Bess Shay, Shaffrey Christopher I, Passias Peter G, Schwab Frank J, Ames Christopher P, Lafage Virginie
Spine Service, Hospital for Special Surgery, New York, NY, USA.
Department of Orthopaedic, Taipei Veterans General Hospital, Taipei, Taiwan.
Global Spine J. 2023 May;13(4):1056-1063. doi: 10.1177/21925682211017478. Epub 2021 May 20.
Comparative cohort study.
Factors that influence the lower instrumented vertebra (LIV) selection in adult cervical deformity (ACD) are less reported, and outcomes in the cervicothoracic junction (CTJ) and proximal thoracic (PT) spine are unclear.
A prospective ACD database was analyzed using the following inclusion criteria: LIV between C7 and T5, upper instrumented vertebra at C2, and at least a 1-year follow-up. Patients were divided into CTJ (LIV C7-T2) and PT groups (LIV T3-T5) based on LIV levels. Demographics, operative details, radiographic parameters, and the health-related quality of life (HRQOL) scores were compared.
Forty-six patients were included (mean age, 62 years), with 22 and 24 patients in the CTJ and PT groups, respectively. Demographics and surgical parameters were comparable between the groups. The PT group had a significantly higher preoperative C2-C7 sagittal vertical axis (cSVA) (46.9 mm vs 32.6 mm, = 0.002) and T1 slope minus cervical lordosis (45.9° vs 36.0°, = 0.042) than the CTJ group and was more likely treated with pedicle-subtraction osteotomy (33.3% vs 0%, = 0.004). The PT group had a larger correction of cSVA (-7.7 vs 0.7 mm, = 0.037) and reciprocal change of increased T4-T12 kyphosis (8.6° vs 0.0°, = 0.001). Complications and reoperations were comparable. The HRQOL scores were not different preoperatively and at 1-year follow-up.
The selection of PT LIV in cervical deformities was more common in patients with larger baseline deformities, who were more likely to undergo pedicle-subtraction osteotomy. Despite this, the complications and HRQOL outcomes were comparable at 1-year follow-up.
比较队列研究。
关于影响成人颈椎畸形（ACD）中下位固定椎体（LIV）选择的因素报道较少，且颈胸交界区（CTJ）和上胸椎（PT）脊柱的治疗结果尚不清楚。
使用以下纳入标准对前瞻性ACD数据库进行分析：LIV在C7和T5之间，上位固定椎体在C2，且至少随访1年。根据LIV水平将患者分为CTJ组（LIV为C7 - T2）和PT组（LIV为T3 - T5）。比较人口统计学资料、手术细节、影像学参数以及健康相关生活质量（HRQOL）评分。
共纳入46例患者（平均年龄62岁），CTJ组和PT组分别有22例和24例。两组的人口统计学资料和手术参数具有可比性。PT组术前C2 - C7矢状面垂直轴（cSVA）显著高于CTJ组（46.9 mm对32.6 mm，P = 0.002），T1斜率减去颈椎前凸也更高（45.9°对36.0°，P = 0.042），且更有可能接受经椎弓根截骨术（33.3%对0%，P = 0.004）。PT组cSVA的矫正幅度更大（-7.7对0.7 mm，P = 0.037），T4 - T12后凸增加的交互变化更大（8.6°对0.0°，P = 0.001）。并发症和再次手术情况相当。术前和随访1年时HRQOL评分无差异。
颈椎畸形中选择PT作为LIV在基线畸形较大的患者中更常见，这些患者更有可能接受经椎弓根截骨术。尽管如此，随访1年时并发症和HRQOL结果相当。
