Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Guoxue Lane, Chengdu, 610041, Sichuan Province, China.
BMC Musculoskelet Disord. 2022 Jul 5;23(1):641. doi: 10.1186/s12891-022-05606-0.
PURPOSE: To investigate the relationship between the preoperative paraspinal Goutalier grade of fatty infiltration and postoperative cervical sagittal alignment in patients undergoing anterior cervical discectomy and fusion (ACDF). METHODS: A total of 101 patients who underwent single-level ACDF with the Zero-profile implant system between March 2011 and April 2020 were included in this study. Cervical sagittal alignment parameters, including the C2-C7 Cobb angle, functional spinal unit (FSU) angle, cervical sagittal vertical axis (SVA), and T1 slope (T1S), were assessed. Preoperative magnetic resonance images were used to classify patients according to Goutalier grade. Clinical outcomes including Neck Disability Index (NDI) scores, Japanese Orthepaedic Association (JOA) scores and Visual Analogue Scale (VAS) scores were collected and analyzed. RESULTS: According to the Goutalier grade, 33 patients were classified as Goutalier 0-1 (Group A), 44 were classified as Goutalier 1.5-2 (Group B), and 24 were classified as Goutalier 2.5-4.0 (Group C). The mean age among the three groups showed significant differences (P = 0.007). At the last follow-up, the C2-C7 Cobb angle, FSU angle, and T1S improved after the surgery among the groups. Although there were varying degrees of loss of curvature among the different groups during the follow-up period, the postoperative cervical sagittal alignment parameters demonstrated no statistical differences among the three groups (P > 0.05). In addition, patients in all groups experienced significant relief of their symptoms, and the clinical scores were comparable among the groups (P > 0.05). CONCLUSION: The complex nature of anterior cervical surgery requires surgical attention both in decompression and sagittal alignment. Our study demonstrates satisfactory postoperative cervical sagittal alignment of patients despite different grades of fatty infiltration of the multifidus muscle following single-level ACDF. Based on our results, the improvement and maintenance of cervical sagittal alignment after ACDF remains a complex problem that spine surgeons should consider before surgery.
目的：探讨术前多裂肌脂肪浸润程度与接受前路颈椎间盘切除融合术（ACDF）患者术后颈椎矢状位平衡之间的关系。
方法：回顾性分析 2011 年 3 月至 2020 年 4 月期间采用零切迹植入物系统行单节段 ACDF 的 101 例患者的临床资料。评估颈椎矢状位参数，包括 C2-C7 Cobb 角、功能单位角（FSU）、颈椎矢状垂直轴（SVA）和 T1 斜率（T1S）。术前磁共振成像（MRI）按 Goutalier 分级对患者进行分类。收集并分析患者的临床结果，包括颈痛残疾指数（NDI）评分、日本矫形协会（JOA）评分和视觉模拟量表（VAS）评分。
结果：根据 Goutalier 分级，33 例患者被分为 Goutalier 0-1 级（A 组），44 例患者被分为 Goutalier 1.5-2 级（B 组），24 例患者被分为 Goutalier 2.5-4.0 级（C 组）。三组间平均年龄差异有统计学意义（P=0.007）。末次随访时，三组患者的 C2-C7 Cobb 角、FSU 角和 T1S 均较术前改善。虽然在随访期间各组的曲率都有不同程度的丢失，但术后颈椎矢状位平衡参数在三组间差异无统计学意义（P＞0.05）。此外，各组患者症状均得到显著缓解，且组间临床评分无差异（P＞0.05）。
结论：前路颈椎手术的复杂性需要在减压和矢状位平衡方面都给予手术关注。本研究表明，在接受单节段 ACDF 治疗的患者中，尽管多裂肌脂肪浸润程度不同，但术后颈椎矢状位仍能获得满意的平衡。基于我们的研究结果，在接受 ACDF 之前，脊柱外科医生应该考虑手术对颈椎矢状位平衡的改善和维持问题，这是一个复杂的问题。
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