Division of Spinal Surgery/Department of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, New York, NY.
Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, NY, NY.
Spine (Phila Pa 1976). 2022 Nov 15;47(22):1574-1582. doi: 10.1097/BRS.0000000000004419. Epub 2022 Jul 1.
Retrospective cohort study.
Assess changes in outcomes and surgical approaches for adult cervical deformity surgery over time.
As the population ages and the prevalence of cervical deformity increases, corrective surgery has been increasingly seen as a viable treatment. Dramatic surgical advancements and expansion of knowledge on this procedure have transpired over the years, but the impact on cervical deformity surgery is unknown.
Adult cervical deformity patients (18 yrs and above) with complete baseline and up to the two-year health-related quality of life and radiographic data were included. Descriptive analysis included demographics, radiographic, and surgical details. Patients were grouped into early (2013-2014) and late (2015-2017) by date of surgery. Univariate and multivariable regression analyses were used to assess differences in surgical, radiographic, and clinical outcomes over time.
A total of 119 cervical deformity patients met the inclusion criteria. Early group consisted of 72 patients, and late group consisted of 47. The late group had a higher Charlson Comorbidity Index (1.3 vs. 0.72), more cerebrovascular disease (6% vs. 0%, both P <0.05), and no difference in age, frailty, deformity, or cervical rigidity. Controlling for baseline deformity and age, late group underwent fewer three-column osteotomies [odds ratio (OR)=0.18, 95% confidence interval (CI): 0.06-0.76, P =0.014]. At the last follow-up, late group had less patients with: a moderate/high Ames horizontal modifier (71.7% vs. 88.2%), and overcorrection in pelvic tilt (4.3% vs. 18.1%, both P <0.05). Controlling for baseline deformity, age, levels fused, and three-column osteotomies, late group experienced fewer adverse events (OR=0.15, 95% CI: 0.28-0.8, P =0.03), and neurological complications (OR=0.1, 95% CI: 0.012-0.87, P =0.03).
Despite a population with greater comorbidity and associated risk, outcomes remained consistent between early and later time periods, indicating general improvements in care. The later cohort demonstrated fewer three-column osteotomies, less suboptimal realignments, and concomitant reductions in adverse events and neurological complications. This may suggest a greater facility with less invasive techniques.
回顾性队列研究。
评估成人颈椎畸形手术的结果和手术方法随时间的变化。
随着人口老龄化和颈椎畸形患病率的增加，矫正手术已逐渐被视为一种可行的治疗方法。多年来，手术技术取得了显著进展，对该手术的认识也不断扩大，但对颈椎畸形手术的影响尚不清楚。
纳入了具有完整基线资料和最长两年健康相关生活质量和影像学资料的成年颈椎畸形患者（18 岁及以上）。描述性分析包括人口统计学、影像学和手术细节。根据手术日期将患者分为早期（2013-2014 年）和晚期（2015-2017 年）。采用单变量和多变量回归分析评估随时间推移手术、影像学和临床结果的差异。
共有 119 例颈椎畸形患者符合纳入标准。早期组 72 例，晚期组 47 例。晚期组Charlson 合并症指数更高（1.3 比 0.72），脑血管疾病更多（6%比 0%，均 P<0.05），但年龄、脆弱性、畸形或颈椎僵硬无差异。在控制基线畸形和年龄的情况下，晚期组接受的三柱截骨术更少[比值比（OR）=0.18，95%置信区间（CI）：0.06-0.76，P=0.014]。在最后一次随访时，晚期组患者中：中度/高度 Ames 水平校正值（71.7%比 88.2%）和骨盆倾斜过度矫正值（4.3%比 18.1%，均 P<0.05）更少。在控制基线畸形、年龄、融合节段和三柱截骨术的情况下，晚期组不良事件（OR=0.15，95%CI：0.28-0.8，P=0.03）和神经并发症（OR=0.1，95%CI：0.012-0.87，P=0.03）的发生率更低。
尽管患者合并症和相关风险更高，但早期和晚期之间的结果仍然一致，表明治疗水平普遍提高。晚期组患者三柱截骨术更少，矫正效果不理想的情况更少，同时不良事件和神经并发症也减少。这可能表明采用了更微创技术。
