Kaye Ian David, Sebastian Arjun S, Wagner Scott C, Semenza Nicholas, Bowles Daniel, Schroeder Gregory D, Kepler Chris K, Woods Barret I, Radcliff Kris E, Kurd Mark F, Rihn Jeff, Anderson David Greg, Hilibrand Alan S, Vaccaro Alexander R
Rothman Institute Orthopaedics, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Orthopedics, Mayo Clinic, Rochester, MN, USA.
Global Spine J. 2023 Jul;13(6):1641-1645. doi: 10.1177/21925682211046906. Epub 2021 Sep 27.
This study is a retrospective case control.
This study aims to determine whether cervical degenerative spondylolisthesis (DS) is associated with increased baseline neck/arm pain and inferior health quality states compared to a similar population without DS.
Patient demographics, pre-operative radiographs, and baseline PROMs were reviewed for 315 patients undergoing anterior cervical decompression and fusion (ACDF) with at least 1 year of follow-up. Patients were categorized based on the presence (S) or absence of a spondylolisthesis (NS). Statistically significant variables were further explored using multiple linear regression analysis.
49/242 (20%) patients were diagnosed with DS, most commonly at the C4-5 level (27/49). The S group was significantly older than the NS group (58.0 ± 10.7 vs 51.9 ± 9.81, = .001), but otherwise, no demographic differences were identified. Although a higher degree of C2 slope was found among the S cohort (22.5 ± 8.63 vs 19.8 ± 7.78, = .044), no differences were identified in terms of preoperative visual analogue scale (VAS) neck pain or NDI. In the univariate analysis, the NS group had significantly increased VAS arm pain relative to the S group (4.93 ± 3.16 vs 3.86 ± 3.30, = .045), which was no longer significant in the multivariate analysis.
Although previous reports have suggested an association between cervical DS and neck pain, we could not associate the presence of DS with increased baseline neck or arm pain. Instead, DS appears to be a relatively frequent (20% in this series) age-related condition reflecting radiographic, rather than necessarily clinical, disease.
本研究为回顾性病例对照研究。
本研究旨在确定与无颈椎退行性椎体滑脱（DS）的相似人群相比，颈椎退行性椎体滑脱是否与基线时颈部/手臂疼痛增加及健康质量状态较差相关。
回顾了315例行颈椎前路减压融合术（ACDF）且至少随访1年的患者的人口统计学资料、术前X线片和基线患者报告结局测量指标（PROMs）。根据是否存在椎体滑脱（S组）将患者分类，无椎体滑脱的为非椎体滑脱组（NS组）。使用多元线性回归分析进一步探究具有统计学意义的变量。
49/242（20%）例患者被诊断为DS，最常见于C4-5节段（27/49）。S组患者年龄显著大于NS组（58.0±10.7岁 vs 51.9±9.81岁，P = 0.001），但除此之外，未发现人口统计学差异。尽管S组C2斜率更高（22.5±8.63 vs 19.8±7.78，P = 0.044），但术前视觉模拟评分法（VAS）颈部疼痛或颈椎功能障碍指数（NDI）方面未发现差异。单因素分析中，NS组VAS手臂疼痛相对于S组显著增加（4.93±3.16 vs 3.86±3.30，P = 0.045），但在多因素分析中不再显著。
尽管既往报告提示颈椎DS与颈部疼痛有关，但我们未发现DS的存在与基线时颈部或手臂疼痛增加相关。相反，DS似乎是一种相对常见（本系列中为20%）的与年龄相关的情况，反映的是影像学而非必然是临床疾病。
