Kim Han Jo, Virk Sohrab, Elysee Jonathan, Ames Christopher, Passias Peter, Shaffrey Christopher, Mundis Gregory, Protopsaltis Themistocles, Gupta Munish, Klineberg Eric, Hart Robert, Smith Justin S, Bess Shay, Schwab Frank, Lafage Renaud, Lafage Virginie
Department of Orthopedics, Hospital for Special Surgery, New York, NY 10021, USA.
Department of Orthopedics, Northwell Health, Great Neck, New York, NY 11021, USA.
J Clin Med. 2021 Oct 21;10(21):4826. doi: 10.3390/jcm10214826.
Cervical deformity morphotypes based on type and location of deformity have previously been described. This study aimed to examine the surgical strategies implemented to treat these deformity types and identify if differences in treatment strategies impact surgical outcomes. Our hypothesis was that surgical strategies will differ based on different morphologies of cervical deformity.
Adult patients enrolled in a prospective cervical deformity database were classified into four deformity types (Flatneck (FN), Focal kyphosis (FK), Cervicothoracic kyphosis (CTK) and Coronal (C)), as previously described. We analyzed group differences in demographics, preoperative symptoms, health-related quality of life scores (HRQOLs), and surgical strategies were evaluated, and postop radiographic and HROQLs at 1+ year follow up were compared.
90/109 eligible patients (mean age 63.3 ± 9.2, 64% female, CCI 1.01 ± 1.36) were evaluated. Group distributions included FN = 33%, FK = 29%, CTK = 29%, and C = 9%. Significant differences were noted in the surgical approaches for the four types of deformities, with FN and FK having a high number of anterior/posterior (APSF) approaches, while CTK and C had more posterior only (PSF) approaches. For FN and FK, PSF was utilized more in cases with prior anterior surgery (70% vs. 25%). For FN group, PSF resulted in inferior neck disability index compared to those receiving APSF suggesting APSF is superior for FN types. CTK types had more three-column osteotomies (3CO) ( < 0.01) and longer fusions with the LIV below T7 ( < 0.01). There were no differences in the UIV between all deformity types ( = 0.19). All four types of deformities had significant improvement in NRS neck pain post-op ( < 0.05) with their respective surgical strategies.
The four types of cervical deformities had different surgical strategies to achieve improvements in HRQOLs. FN and FK types were more often treated with APSF surgery, while types CTK and C were more likely to undergo PSF. CTK deformities had the highest number of 3COs. This information may provide guidelines for the successful management of cervical deformities.
先前已描述了基于畸形类型和位置的颈椎畸形形态学类型。本研究旨在探讨治疗这些畸形类型所采用的手术策略，并确定治疗策略的差异是否会影响手术结果。我们的假设是，手术策略将因颈椎畸形的不同形态而有所不同。
将纳入前瞻性颈椎畸形数据库的成年患者分为四种畸形类型（扁平颈（FN）、局灶性后凸（FK）、颈胸段后凸（CTK）和冠状面（C）），如先前所述。我们分析了人口统计学、术前症状、健康相关生活质量评分（HRQOL）方面的组间差异，评估了手术策略，并比较了1年以上随访时的术后影像学和HRQOL。
对90/109例符合条件的患者（平均年龄63.3±9.2岁，64%为女性，CCI为1.01±1.36）进行了评估。组间分布包括FN=33%，FK=29%，CTK=29%，C=9%。四种畸形类型的手术入路存在显著差异，FN和FK采用前后联合（APSF）入路的数量较多，而CTK和C采用单纯后路（PSF）入路的更多。对于FN和FK，既往有前路手术的病例更多采用PSF（70%对25%）。对于FN组，与接受APSF的患者相比，PSF导致的颈部残疾指数更低，提示APSF对FN类型更具优势。CTK类型的三柱截骨术（3CO）更多（<0.01），与T7以下的终末椎体融合更长（<0.01）。所有畸形类型之间的上位终末椎体无差异（=0.19）。所有四种畸形类型采用各自的手术策略后，术后NRS颈部疼痛均有显著改善（<0.05）。
四种颈椎畸形类型采用不同的手术策略以改善HRQOL。FN和FK类型更常采用APSF手术，而CTK和C类型更可能接受PSF。CTK畸形的3CO数量最多。这些信息可为颈椎畸形的成功治疗提供指导。
