Lu Xiao, Xu Guang-Yu, Nie Cong, Zhang Yu Xuan, Song Jian, Jiang Jian-Yuan
Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai, China.
Neurospine. 2021 Sep;18(3):618-627. doi: 10.14245/ns.2142564.282. Epub 2021 Sep 30.
Anterior cervical discectomy and fusion (ACDF) is a common surgical method used to treat patients with Hirayama disease. And sagittal balance indexes have been revealed to be predictors of clinical outcomes in patients with cervical diseases, but their relationships with ACDF-treated Hirayama disease outcomes remain unknown. The purpose of this study is to evaluate the relationship of preoperative cervical sagittal balance indexes and clinical outcomes in ACDF-treated Hirayama disease patients.
Eighty patients with Hirayama disease treated by ACDF were reviewed retrospectively. Six cervical sagittal balance parameters were collected including Cobb angle, T1 slope, C1-7 sagittal vertical axis (SVA), C2-7 SVA, center of gravity of the head (CGH)-C7 SVA, range of motion. The recovery outcomes of the patients were divided into 2 groups by Odom score and the differences in recovery between the 2 groups were confirmed by electromyography. The correlation between imaging parameters and postoperative outcome was evaluated with logistic regression. The receiver operating characteristic (ROC) curve and area under the ROC curve (AUC) were used to evaluate the significant result of logistic regression and the optimal diagnostic value.
Only 2 parameters, Cobb angle and CGH-C7 SVA, showed statistical correlation with the postoperative outcome assessment by logistic regression. AUC of Cobb angle and CGH-C7 SVA were 0.559 and 0.702 respectively. The optimal predictive threshold was 1.50° and 5.40 mm, respectively.
A larger Cobb angle and smaller CGH-C7 SVA seemed to correlate with a better postoperative outcome. These 2 factors could be used to predict the outcome of surgical treatment of Hirayama disease preoperatively.
颈椎前路椎间盘切除融合术（ACDF）是治疗平山病患者的常用手术方法。矢状面平衡指标已被证明是颈椎病患者临床预后的预测指标，但其与ACDF治疗平山病预后的关系尚不清楚。本研究的目的是评估ACDF治疗平山病患者术前颈椎矢状面平衡指标与临床预后的关系。
回顾性分析80例行ACDF治疗的平山病患者。收集6项颈椎矢状面平衡参数，包括Cobb角、T1斜率、C1-7矢状垂直轴（SVA）、C2-7 SVA、头部重心（CGH）-C7 SVA、活动范围。根据Odom评分将患者的恢复结果分为2组，并通过肌电图确认2组恢复情况的差异。采用逻辑回归评估影像学参数与术后结果的相关性。采用受试者工作特征（ROC）曲线及ROC曲线下面积（AUC）评估逻辑回归的显著结果及最佳诊断价值。
逻辑回归分析显示，只有Cobb角和CGH-C7 SVA这2项参数与术后结果评估具有统计学相关性。Cobb角和CGH-C7 SVA的AUC分别为0.559和0.702。最佳预测阈值分别为1.50°和5.40 mm。
较大的Cobb角和较小的CGH-C7 SVA似乎与较好的术后结果相关。这2个因素可用于术前预测平山病手术治疗的结果。
