Imajo Yasuaki, Nishida Norihiro, Funaba Masahiro, Nagao Yuji, Suzuki Hidenori, Sakai Takashi
Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, Ube, Japan.
Asian Spine J. 2022 Oct;16(5):723-731. doi: 10.31616/asj.2021.0210. Epub 2022 Apr 6.
An observational cohort study design was adopted in this study.
This study was designed to investigate preoperative factors that predict poor outcomes following surgery in patients with proximal-type cervical spondylotic amyotrophy (PCSA) using radiological findings.
We evaluated the preoperative factors associated with poor outcomes using electrophysiological and neurological findings. However, the preoperative factors associated with poor outcomes remained unclear.
Sixty patients with PCSA who underwent surgical treatment of the cervical spine were enrolled. The radiological findings on plain radiographs, computed tomography (CT), and magnetic resonance imaging (MRI) were evaluated. The cervical lordotic angles, C2-C7 sagittal vertical axis (SVA), and T1 slope were assessed on a lateral radiograph in the neutral position. CT was used to assess the width of the intervertebral foramen and the anterior protrusion of the superior articular process on the axial view. MRI was used to determine the number of levels of compression (NLC) and the presence of a high-intensity area in the spinal cord in the T2- weighted midsagittal view. The preoperative and postoperative strengths of the most atrophic muscles were evaluated using manual muscle testing. Improvements in strength were classified as excellent (five grades recovered), good (more than one grade recovered), fair (no improvement), or poor (worsened).
The prevalence of C5 palsy was 17% (10/60). Patients with poor outcomes had higher NLC and Δ C2-C7 SVA than patients with excellent, good, and fair outcomes (p =0.015; odds ratio [OR], 5.758; 95% confidence interval [CI], 1.397-23.726 for a change of 10% and p =0.048; OR, 1.068; 95% CI, 0.992-1.141 for a change of 10%, respectively).
ΔC2-C7 SVA and NLC may be used as prognostic factors for achieving a poor outcome following surgery in patients with PCSA. More focus is needed on preventing the increase in ΔC2-C7 SVA.
本研究采用观察性队列研究设计。
本研究旨在利用影像学检查结果，调查预测近端型颈椎病性肌萎缩（PCSA）患者术后预后不良的术前因素。
我们利用电生理和神经学检查结果评估了与预后不良相关的术前因素。然而，与预后不良相关的术前因素仍不明确。
纳入60例行颈椎手术治疗的PCSA患者。评估了X线平片、计算机断层扫描（CT）和磁共振成像（MRI）的影像学检查结果。在中立位的侧位X线片上评估颈椎前凸角、C2-C7矢状垂直轴（SVA）和T1斜率。CT用于在轴位视图上评估椎间孔宽度和上关节突的前凸情况。MRI用于确定T2加权矢状位中线视图中脊髓受压节段数（NLC）和脊髓内高强度区域的存在情况。使用徒手肌力测试评估最萎缩肌肉术前和术后的力量。力量改善分为优（恢复五级）、良（恢复超过一级）、中（无改善）或差（恶化）。
C5麻痹的发生率为17%（10/60）。预后不良的患者比预后优、良和中的患者具有更高的NLC和ΔC2-C7 SVA（p = 0.015；优势比[OR]，5.758；95%置信区间[CI]，1.397 - 23.726，变化10%时；p = 0.048；OR，1.068；95%CI，0.992 - 1.141，变化10%时）。
ΔC2-C7 SVA和NLC可作为PCSA患者术后预后不良的预测因素。需要更加关注预防ΔC2-C7 SVA的增加。
