Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
Orthop Surg. 2022 Aug;14(8):1790-1798. doi: 10.1111/os.13385. Epub 2022 Jul 12.
At present, the true sagittal alignment of the cervical spine is uncertain, resulting in no standard reference for subaxial cervical surgery. So, we aimed to explore the age difference of normal cervical sagittal alignment and to further investigate the mid-and long-term changes of sagittal alignment after subaxial cervical spine surgery.
This was a retrospective study and 1223 asymptomatic volunteers and 79 patients undergoing subaxial cervical spine surgery were retrospectively reviewed in total. Asymptomatic volunteers and patients were divided into six subgroups: 20-29, 30-39, 40-49, 50-59, 60-69 and ≥70 groups. The age difference and trend with age of cervical sagittal parameters of asymptomatic volunteers were assessed by cervical lateral radiography and analyzed by ANOVA test, and the regression equation of C2-7 Cobb was established via multiple linear regression. Based on the C2-7 Cobb regression equations of different ages, the theoretical value, deviation value, loss value of the C2-7 Cobb, and JOA recovery rate of patients were calculated, and the correlation among the loss value, deviation value of the C2-7 Cobb, and JOA recovery rate of the 79 patients was evaluated by Pearson correlation analysis.
For the asymptomatic volunteers, the C0-2 Cobb decreased gradually with increasing age. The C2-7 Cobb, C2-7 SVA, T1S, NT, and TIA increased gradually with increasing age. The CBVA fluctuated with increasing age. T1S demonstrated a moderate correlation with C2-7 Cobb (r = 0.60, p < 0.01); C0-2 Cobb, C2-7 SVA, CBVA, and TIA demonstrated a fair correlation with C2-7 Cobb (r = -0.30, -0.33, 0.41, 0.40, p < 0.01); age demonstrated a poor correlation with C2-7 Cobb (r = 0.19, p < 0.01). The regression equations of C2-7 Cobb were established using C0-2 Cobb, C2-7 SVA, CBVA, and T1S. For the patients with subaxial cervical spine surgery, the loss of C2-7 Cobb was moderately correlated with the deviation of C2-7 Cobb (r = 0.33, p < 0.01).
The age difference of cervical sagittal alignment was obvious, and the C2-7 Cobb increased with age especially. The closer the postoperative C2-7 Cobb was to the theoretical value of corresponding age, the smaller the loss of correction angle was, and the better the mid- and long-term outcomes. The personalized sagittal reconstruction should be performed according to age difference for subaxial cervical spine surgery.
目前，颈椎矢状位的真实排列尚不确定，导致下位颈椎手术缺乏标准参考。因此，本研究旨在探讨正常颈椎矢状位排列的年龄差异，并进一步研究下位颈椎手术后矢状位排列的中期和长期变化。
本研究为回顾性研究，共回顾性分析了 1223 名无症状志愿者和 79 名接受下位颈椎手术的患者。将无症状志愿者和患者分为 6 个亚组：20-29 岁、30-39 岁、40-49 岁、50-59 岁、60-69 岁和≥70 岁组。通过颈椎侧位片评估无症状志愿者颈椎矢状参数的年龄差异和趋势，并采用方差分析进行评估，通过多元线性回归建立 C2-7 Cobb 的回归方程。基于不同年龄的 C2-7 Cobb 回归方程，计算患者的 C2-7 Cobb 理论值、偏差值、丢失值和 JOA 恢复率，并通过 Pearson 相关分析评估 79 例患者的 C2-7 Cobb 丢失值、偏差值与 JOA 恢复率之间的相关性。
对于无症状志愿者，C0-2 Cobb 随着年龄的增长逐渐减小。C2-7 Cobb、C2-7 SVA、T1S、NT 和 TIA 随着年龄的增长逐渐增加。CBVA 随年龄波动。T1S 与 C2-7 Cobb 呈中度相关（r=0.60，p<0.01）；C0-2 Cobb、C2-7 SVA、CBVA 和 TIA 与 C2-7 Cobb 呈中等相关（r=-0.30、-0.33、0.41 和 0.40，p<0.01）；年龄与 C2-7 Cobb 呈低度相关（r=0.19，p<0.01）。使用 C0-2 Cobb、C2-7 SVA、CBVA 和 T1S 建立了 C2-7 Cobb 的回归方程。对于接受下位颈椎手术的患者，C2-7 Cobb 的丢失与 C2-7 Cobb 的偏差呈中度相关（r=0.33，p<0.01）。
颈椎矢状位排列的年龄差异明显，C2-7 Cobb 随年龄增长而增加。术后 C2-7 Cobb 越接近相应年龄的理论值，矫正角度丢失越小，中远期效果越好。下位颈椎手术应根据年龄差异进行个性化矢状位重建。
