Passias Peter Gust, Passfall Lara, Horn Samantha R, Pierce Katherine E, Lafage Virginie, Lafage Renaud, Smith Justin S, Line Breton G, Mundis Gregory M, Eastlack Robert, Diebo Bassel G, Protopsaltis Themistocles S, Kim Han Jo, Scheer Justin, Burton Douglas C, Hart Robert A, Schwab Frank J, Bess Shay, Ames Christopher P, Shaffrey Christopher I
Departments of Orthopaedic and Neurosurgery, Division of Spinal Surgery, NYU Langone Medical Center, NY Spine Institute, New York, NY, USA.
Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
J Craniovertebr Junction Spine. 2021 Jul-Sep;12(3):263-268. doi: 10.4103/jcvjs.jcvjs_35_21. Epub 2021 Sep 8.
Osteotomies are commonly performed to correct sagittal malalignment in cervical deformity (CD). However, the risks and benefits of performing a major osteotomy for cervical deformity correction have been understudied. The objective of this retrospective cohort study was to investigate the risks and benefits of performing a major osteotomy for CD correction.
Patients stratified based on major osteotomy (MAJ) or minor (MIN). Independent -tests and Chi-squared tests were used to assess differences between MAJ and MIN. A sub-analysis compared patients with flexible versus rigid CL.
137 CD patients were included (62 years, 65% F). 19.0% CD patients underwent a MAJ osteotomy. After propensity score matching for cSVA, 52 patients were included. About 19.0% CD patients underwent a MAJ osteotomy. MAJ patients had more minor complications ( = 0.045), despite similar surgical outcomes as MIN. At 3M, MAJ and MIN patients had similar NDI, mJOA, and EQ5D scores, however by 1 year, MAJ patients reached MCID for NDI less than MIN patients ( = 0.003). MAJ patients with rigid deformities had higher rates of complications (79% vs. 29%, = 0.056) and were less likely to show improvement in NDI at 1 year (0.95 vs. 0.54, = 0.027). Both groups had similar sagittal realignment at 1 year (all > 0.05).
Cervical deformity patients who underwent a major osteotomy had similar clinical outcomes at 3-months but worse outcomes at 1-year as compared to minor osteotomies, likely due to differences in baseline deformity. Patients with rigid deformities who underwent a major osteotomy had higher complication rates and worse clinical improvement despite similar realignment at 1 year.
截骨术常用于矫正颈椎畸形（CD）中的矢状面排列不齐。然而，对于通过大型截骨术矫正颈椎畸形的风险和益处的研究较少。这项回顾性队列研究的目的是调查通过大型截骨术矫正颈椎畸形的风险和益处。
根据大型截骨术（MAJ）或小型截骨术（MIN）对患者进行分层。采用独立样本t检验和卡方检验评估MAJ组和MIN组之间的差异。一项亚分析比较了柔韧性与僵硬性颈椎后凸患者。
纳入137例颈椎畸形患者（平均年龄62岁，65%为女性）。19.0%的颈椎畸形患者接受了大型截骨术。在对颈椎矢状面垂直轴（cSVA）进行倾向评分匹配后，纳入52例患者。约19.0%的颈椎畸形患者接受了大型截骨术。大型截骨术患者有更多轻微并发症（P = 0.045），尽管手术结果与小型截骨术患者相似。在术后3个月时，大型截骨术组和小型截骨术组患者的颈椎功能障碍指数（NDI）、改良日本骨科协会（mJOA）评分和欧洲五维度健康量表（EQ5D）得分相似，但到1年时，大型截骨术组患者达到NDI最小临床重要差异（MCID）的比例低于小型截骨术组患者（P = 0.003）。僵硬畸形的大型截骨术患者并发症发生率更高（79%对29%，P = 0.056），且1年时NDI改善的可能性更小（0.95对0.54，P = 0.027）。两组在1年时矢状面排列矫正情况相似（所有P>0.05）。
与小型截骨术相比，接受大型截骨术的颈椎畸形患者在术后3个月时临床结果相似，但在1年时结果更差，这可能是由于基线畸形的差异所致。接受大型截骨术的僵硬畸形患者并发症发生率更高，临床改善情况更差，尽管1年时矢状面排列矫正情况相似。
