Pierce Katherine E, Krol Oscar, Lebovic Jordan, Kummer Nicholas, Passfall Lara, Ahmad Waleed, Naessig Sara, Diebo Bassel, Passias Peter Gust
Department of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, Brooklyn, NY, USA.
Department of Orthopedics, SUNY Downstate, Brooklyn, NY, USA.
J Craniovertebr Junction Spine. 2022 Jan-Mar;13(1):67-71. doi: 10.4103/jcvjs.jcvjs_67_21. Epub 2022 Mar 9.
The myelopathy-based cervical deformity (CD) thresholds will associate with patient-reported outcomes and complications.
This study include CD patients (C2-C7 Cobb > 10°, CL > 10°, cervical sagittal vertical axis > 4 cm, or CBVA > 25°) with BL and 1-year (1Y) data. Modifiers assessed low (L), moderate (M), and severe (S) deformity: CL (L: >3°; M:-21° to 3°; S: <‒21°), TS-CL (L: <26°; M: 26° to 45°; S: >45°), C2-T3 angle (L: >‒25°; M:-35° to-25°; S: <‒35°), C2 slope (L: <33°; M: 33° to 49°; S: >49°), MGS (L: >‒9° and < 0°; M: ‒12° to ‒9° or 0° to 19°; S: < ‒12° or > 19°), and frailty (L: <0.18; M: 0.18-0.27, S: >0.27). Means comparison and ANOVA assessed outcomes in the severity groups at BL at 1Y. Correlations found between modifiers assessed the internal relationship.
One hundred and four patients were included in the study (57.1 years, 50%, 29.3 kg/m). Baseline S TS-CL, C2-T3, and C2S modifiers were associated with increased reoperations ( < 0.01), while S MGS, CL, and C2-T3 had increased estimated blood lost (>1000ccs, < 0.001). S MGS and C2-T3 had more postop DJK (60%, = 0.018). Improvement in TS-CL, C2S, C2-T3, and CL patients had better numeric rating scale (NRS) back (<5) and EuroQOL 5-Dimension questionnaire (EQ5D) at 1 year ( < 0.05). Improving the modifiers correlated strongly with each other (0.213-0.785, < 0.001). Worsened TS-CL had increased NRS back scores at 1 year (9, = 0.042). Worsened CL had increased 1-year modified Japanese Orthopedic Association (mJOA) (7, = 0.001). Worsened C2-T3 had worse NRS neck scores at 1 year ( = 0.048). Improvement in all six modifiers (8.7%) had significantly better health-related quality of life (HRQL) scores at follow-up (EQ5D, NRS, and Neck Disability Index).
Newly proposed CD modifiers based on mJOA were closely associated with outcomes. Improvement and deterioration in the modifiers significantly impacted the HRQL.
基于脊髓病的颈椎畸形（CD）阈值将与患者报告的结局及并发症相关。
本研究纳入了具有基线（BL）和1年（1Y）数据的CD患者（C2 - C7 Cobb角>10°、颈椎后凸（CL）>10°、颈椎矢状垂直轴>4 cm或颈椎侧方偏移（CBVA）>25°）。修正因素评估了轻度（L）、中度（M）和重度（S）畸形：CL（L：>3°；M：-21°至3°；S：<-21°）、胸7 - 颈椎后凸（TS - CL）（L：<26°；M：26°至45°；S：>45°）、C2 - T3角（L：>-25°；M：-35°至-25°；S：<-35°）、C2斜率（L：<33°；M：33°至49°；S：>49°）、颈椎矢状面平均坡度（MGS）（L：>-9°且<0°；M：-12°至-9°或0°至19°；S：<-12°或>19°）以及虚弱程度（L：<0.18；M：0.18 - 0.27；S：>0.27）。均值比较和方差分析评估了各严重程度组在基线和1年时的结局。通过评估修正因素之间的相关性来发现内在关系。
本研究共纳入104例患者（年龄57.1岁，50%为女性，体重指数29.3 kg/m²）。基线时重度TS - CL（胸7 - 颈椎后凸）、C2 - T3和C2斜率修正因素与再次手术增加相关（P<0.01），而重度MGS（颈椎矢状面平均坡度）、CL（颈椎后凸）和C2 - T3的估计失血量增加（>1000cc，P<0.001）。重度MGS和C2 - T3术后出现更多的相邻节段退变（DJK）（60%，P = 0.018）。TS - CL、C2斜率、C2 - T3和CL改善的患者在1年时数字评定量表（NRS）背痛评分（<5）和欧洲五维健康量表（EQ5D）更好（P<0.05）。各修正因素之间的改善情况相关性很强（r = 0.213 - 0.785，P<0.001）。TS - CL恶化的患者在1年时NRS背痛评分增加（P = 0.042）。CL恶化的患者1年时改良日本骨科协会（mJOA）评分增加（P = 0.001）。C2 - T3恶化的患者在1年时NRS颈部评分更差（P = 0.048）。所有六个修正因素均有改善的患者（8.7%）在随访时健康相关生活质量（HRQL）评分（EQ5D、NRS和颈部残疾指数）显著更好。
新提出的基于改良日本骨科协会（mJOA）的CD修正因素与结局密切相关。修正因素的改善和恶化对健康相关生活质量有显著影响。
