Alas Haddy, Passias Peter Gust, Diebo Bassel G, Brown Avery E, Pierce Katherine E, Bortz Cole, Lafage Renaud, Ames Christopher P, Line Breton, Klineberg Eric O, Burton Douglas C, Uribe Juan S, Kim Han Jo, Daniels Alan H, Bess Shay, Protopsaltis Themistocles, Mundis Gregory M, Shaffrey Christopher I, Schwab Frank J, Smith Justin S, Lafage Virginie
Department of Orthopaedic and Neurosurgery, Division of Spinal Surgery, NYU Langone Orthopaedic Hospital, NY Spine Institute, New York City, USA.
Department of Orthopaedic Surgery, Downstate Medical Center, State University of New York, Brooklyn, NY, USA.
J Craniovertebr Junction Spine. 2021 Jul-Sep;12(3):279-286. doi: 10.4103/jcvjs.jcvjs_29_21. Epub 2021 Sep 8.
Patients with symptomatic cervical deformity (CD) requiring surgical correction often present with hyperkyphosis (HK), though patients with hyperlordotic curves may require surgery as well. Few studies have investigated differences in CD-corrective surgery with regards to HK and hyperlordosis (HL).
Operative CD patients (C2-C7 Cobb >10°, cervical lordosis [CL] >10°, cervical sagittal vertical axis [cSVA] >4 cm, chin-brow vertical angle >25°) with baseline (BL) and 1Y radiographic data. Patients were stratified based on BL C2-7 lordosis (CL) angle: those >1 standard deviation (SD) from the mean (-6.96° ±21.47°) were hyperlordotic (>14.51°) or hyperkyphotic (≤28.43°) depending on directionality. Patients within 1 SD were considered the control group.
One hundred and two surgical CD pts (61 years, 65%F, 30 kg/m) with BL and 1Y radiographic data were included. Twenty pts met definitions for HK and 21 pts met definitions for HL. No differences in demographics or disability were noted. HK had higher estimated blood loss (EBL) with anterior approaches than HL but similar EBL with the posterior approach. Op-time did not differ between groups. Control, HL, and HK groups differed in BL TS-CL (36.6° vs. 22.5° vs. 60.7°, < 0.001) and BL-sagittal vertical axis (SVA) (10.8 vs. 7.0 vs. -47.8 mm, = 0.001). HL pts had less discectomies, less corpectomies, and similar osteotomy rates to HK. HL had × 3 revisions of HK and controls (28.6 vs. 10.0 vs. 9.2%, respectively, = 0.046). At 1Y, HL pts had higher cSVA, and trended higher SVA and SS than HK. In terms of BL-upper cervical alignment, HK pts had higher McGregor's-slope (16.1° vs. -3.3°, = 0.001) and C0-C2 Cobb (43.3° vs. 26.9°, < 0.001), however postoperative differences in McGregor's slope and C0-C2 were not significant. HK drivers of deformity were primarily C (90%), whereas HL had primary computed tomography (38.1%), upper thoracic (23.8%), and C (14.3%) drivers.
Hyperlodotic patients trended higher revision rates with greater radiographic malalignment at 1Y postoperative, perhaps due to undercorrection compared to kyphotic etiologies.
有症状的颈椎畸形（CD）患者若需手术矫正，常伴有后凸畸形（HK），不过颈椎前凸曲线异常的患者也可能需要手术。很少有研究探讨针对HK和颈椎前凸（HL）的CD矫正手术的差异。
纳入有基线（BL）和1年影像学数据的手术治疗的CD患者（C2 - C7 Cobb角>10°，颈椎前凸[CL]>10°，颈椎矢状垂直轴[cSVA]>4 cm，颏眉垂直角>25°）。根据BL C2 - 7前凸（CL）角对患者进行分层：与平均值（-6.96°±21.47°）相差超过1个标准差（SD）的患者，根据方向不同，为颈椎前凸（>14.51°）或后凸（≤28.43°）。1个SD范围内的患者为对照组。
纳入102例有BL和1年影像学数据的手术治疗的CD患者（61岁，65%为女性，体重指数30 kg/m²）。20例患者符合HK定义，21例患者符合HL定义。未观察到人口统计学或残疾方面的差异。HK患者前路手术的估计失血量（EBL）高于HL患者，但后路手术的EBL相似。两组手术时间无差异。对照组、HL组和HK组在BL时的胸段 - 颈椎前凸（TS - CL）（36.6°对22.5°对60.7°，P<0.001）和BL时的矢状垂直轴（SVA）（10.8对7.0对 - 47.8 mm，P = 0.001）存在差异。HL患者的椎间盘切除术、椎体次全切除术较少，截骨率与HK患者相似。HL患者的翻修率是HK患者和对照组的3倍（分别为28.6%对10.0%对9.2%，P = 0.046）。在1年时，HL患者的cSVA更高，SVA和矢状面偏移（SS）也有高于HK患者的趋势。就BL时的上颈椎对线而言，HK患者的麦格雷戈斜率（16.1°对 - 3.3°，P = 0.001）和C0 - C2 Cobb角（43.3°对26.9°，P<0.001）更高，然而术后麦格雷戈斜率和C0 - C2的差异不显著。HK畸形的主要原因是颈椎（90%），而HL的主要原因是计算机断层扫描（38.1%）、上胸椎（23.8%）和颈椎（14.3%）。
颈椎前凸患者术后1年的翻修率较高，影像学对线不良更严重，这可能是由于与后凸病因相比矫正不足所致。
