Roth Steven G, Khan Inamullah, Chotai Silky, Chanbour Hani, Stephens Byron, Abtahi Amir, Devin Clinton J, Zuckerman Scott L
Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN.
Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN.
Spine (Phila Pa 1976). 2022 Apr 1;47(7):565-573. doi: 10.1097/BRS.0000000000004273.
Retrospective cohort study.
(a) Compare operative variables, complications, and patient-reported outcomes (PROs) in patients with an upper instrumented vertebrae (UIV) of C2 versus C3/4, and (b) assess outcomes based on C2 screw type.
When performing elective posterior cervical laminectomy and fusion (PCLF), spine surgeons must choose the upper instrumented vertebrae (UIV) at the subaxial cervical spine (C3/4) versus C2. Differences in long-term complications and PROs remain unknown.
A single-institution, retrospective cohort study from a prospective registry was conducted. All patients undergoing elective, degenerative PCLF from December 2010 to June 2018 were included. Patients were divided into a UIV of C2 versus C3/4. Groups were 2:1 propensity matched for fusion extending to the thoracic spine. Demographics, operative, perioperative, complications, and 1-year PRO data were collected.
One hundred seventeen patients underwent elective PCLF and were successfully propensity matched (39 C2 vs. 78 C3/4). Groups were similar in fusion extending to the thoracic spine (P = 0.588). Expectedly, the C2 group had more levels fused (5.63 ± 1.89) compared with the C3/4 group (4.50 ± 0.91) (P = 0.001). The C2 group had significantly longer operative time (P < 0.001), yet no differences were seen in estimated blood loss (EBL) (P = 0.494) or length of stay (LOS) (P = 0.424). Both groups significantly improved all PROs at 1-year (EQ-5D; NRS-NP/AP; NDI). Both groups had the same percentage of surgical adverse events at 6.8% (P = 1.00). Between C2 screw type, no differences were seen in operative time, EBL, LOS, complications, or PROs.
In patients undergoing elective PCLF, those instrumented to C2 had only longer operative times compared with those stopping at C3/4. No differences were seen in EBL, LOS, 1-year PROs, and complications. Type of C2 screw had no impact on outcomes. Besides increased operative time, instrumenting to C2 had no detectable difference on surgical outcomes or adverse event rates.Level of Evidence: 3.
回顾性队列研究。
(a) 比较颈椎上固定节段（UIV）为C2与C3/4的患者的手术变量、并发症及患者报告结局（PROs），(b) 基于C2螺钉类型评估结局。
在进行选择性后路颈椎椎板切除融合术（PCLF）时，脊柱外科医生必须在颈椎下颈椎（C3/4）与C2之间选择上固定节段（UIV）。长期并发症和PROs的差异仍不明确。
进行一项来自前瞻性登记处的单机构回顾性队列研究。纳入2010年12月至2018年6月期间所有接受选择性退行性PCLF的患者。患者被分为UIV为C2组与C3/4组。两组按2:1倾向评分匹配，以使融合延伸至胸椎。收集人口统计学、手术、围手术期、并发症及1年PRO数据。
117例患者接受了选择性PCLF并成功进行倾向评分匹配（39例C2组 vs. 78例C3/4组）。两组在融合延伸至胸椎方面相似（P = 0.588）。不出所料，C2组融合节段数（5.63 ± 1.89）多于C3/4组（4.50 ± 0.91）（P = 0.001）。C2组手术时间显著更长（P < 0.001），但估计失血量（EBL）（P = 0.494）或住院时间（LOS）（P = 0.424）无差异。两组在1年时所有PROs均显著改善（EQ - 5D；NRS - NP/AP；NDI）。两组手术不良事件发生率均为6.8%（P = 1.00）。在C2螺钉类型之间，手术时间、EBL、LOS、并发症或PROs均无差异。
在接受选择性PCLF的患者中，与固定至C3/4的患者相比，固定至C2的患者仅手术时间更长。EBL、LOS、1年PROs及并发症方面无差异。C2螺钉类型对结局无影响。除手术时间增加外，固定至C2对手术结局或不良事件发生率无明显差异。证据级别：3级。
