Noh Sung Hyun, Takahashi Toshiyuki, Inoue Tomoo, Park Sang-Man, Hanakita Junya, Minami Manabu, Kanematsu Ryo, Shimauchi-Ohtaki Hiroya, Ha Yoon
Department of Neurosurgery, Ajou University College of Medicine, Suwon, Korea.
Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Fujieda, Shizuoka, Japan.
J Clin Neurosci. 2022 Jun;100:148-154. doi: 10.1016/j.jocn.2022.04.005. Epub 2022 Apr 23.
To investigate the incidence of cervical spine deformity and instability after posterior cervical spinal cord tumor (CSCT) resection without fusion or fixation in adults and examine relevant risk factors by reviewing and summarizing previously reported studies.
We selected peer reviewed articles published between January 1990 and December 2020 from the MEDLINE and Cochrane Library databases using relevant key words. Articles in which the authors mainly described spinal cord tumor resection through posterior surgery without fusion or fixation in adults were selected for analysis. Patient's data including age, sex, extensive number of laminectomy levels, laminectomy at C2, C3, or C7, multilevel facetectomy, facet destruction, preoperative cervical kyphosis, and preoperative motor deficit were documented. Comparable factors were assessed using the odds ratio (OR) and weighted mean difference (WMD) of 95% confidence intervals (CI).
Among 133 articles identified, 18 met selection criteria. Overall incidence of deformity and instability after CSCT surgery was 0%-41.7% and 0%-20.5%, respectively. Younger age (WMD, -5.5; 95% CI, -10.52 ∼ -0.49; P = 0.03), C2 laminectomy (OR, 5.33; 95% CI, 2.39 ∼ 11.91; P < 0.0001), more laminectomy level (WMD, 2.77; 95% CI, 1.78 ∼ 3.76; P < 0.00001) were identified as risk factors for deformity and instability after CSCT surgery.
Patients undergoing CSCT resection should receive careful follow-up for postoperative spinal deformity and instability. Younger age, C2 laminectomy, and more laminectomy level were significantly associated with occurrence of deformity and instability after CSCT surgery. Upfront spinal fixation at the time of resection should be considered in selected patients.
通过回顾和总结既往报道的研究，调查成人后路颈段脊髓肿瘤（CSCT）切除术后未行融合或固定时颈椎畸形和不稳定的发生率，并检查相关危险因素。
我们使用相关关键词从MEDLINE和Cochrane图书馆数据库中筛选1990年1月至2020年12月发表的同行评审文章。选择作者主要描述成人经后路手术切除脊髓肿瘤且未行融合或固定的文章进行分析。记录患者数据，包括年龄、性别、广泛椎板切除节段数、C2、C3或C7椎板切除、多节段小关节切除术、小关节破坏、术前颈椎后凸以及术前运动功能障碍。使用95%置信区间（CI）的比值比（OR）和加权平均差（WMD）评估可比因素。
在识别出的133篇文章中，18篇符合入选标准。CSCT手术后畸形和不稳定的总体发生率分别为0% - 41.7%和0% - 20.5%。年龄较小（WMD，-5.5；95%CI，-10.52 ∼ -0.49；P = 0.03）、C2椎板切除（OR，5.33；95%CI，2.39 ∼ 11.91；P < 0.0001）、更多的椎板切除节段（WMD，2.77；95%CI，1.78 ∼ 3.76；P < 0.00001）被确定为CSCT手术后畸形和不稳定的危险因素。
接受CSCT切除术的患者应接受仔细的术后脊柱畸形和不稳定随访。年龄较小、C2椎板切除以及更多的椎板切除节段与CSCT手术后畸形和不稳定的发生显著相关。对于选定的患者，应考虑在切除时进行前路脊柱固定。
