Canseco Jose A, Karamian Brian A, Patel Parthik D, Markowitz Michael, Lee Joseph K, Kurd Mark F, Anderson D Greg, Rihn Jeffrey A, Hilibrand Alan S, Kepler Christopher K, Vaccaro Alexander R, Schroeder Gregory D
Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA.
Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
Int J Spine Surg. 2022 Dec;16(6):960-968. doi: 10.14444/8325. Epub 2022 Jul 14.
Surgeons have scrutinized spinal alignment and its impact on improving clinical outcomes following anterior cervical discectomy and fusion (ACDF). The primary analysis of this study examines the relationship between change in perioperative cervical lordosis (CL) and health-related quality-of-life (HRQOL) outcomes after ACDF. Secondary analysis evaluates the effects of fusion construct length on outcomes in patients grouped by preoperative cervical alignment.
A retrospective cohort study was performed on an institutional database including patients who underwent 1- to 3-level ACDF. C2-C7 CL was measured preoperatively and at final follow-up. For primary analysis, patients were classified based on their perioperative cervical lordotic correction: (1) kyphotic, (2) maintained, and (3) restored. For secondary analysis, patients were categorized based on their preoperative C2-C7 CL: (1) kyphotic, (2) neutral, and (3) lordotic. Demographics and perioperative change in patient-reported outcome measures were compared between groups.
A total of 308 patients were included. A significant difference was noted among maintained, restored, and kyphotic groups in terms of delta physical compositeshort form-12 score (ΔPCS-12) (9.0 vs 10.3 vs 1.5; = 0.04) and delta visual analog scale score (ΔVAS) for arm pain (-0.9 vs -3.8 vs -0.6; = 0.03). Regression analysis revealed significantly greater improvement of PCS-12 (β: 8.6; = 0.03) and VAS arm (β: -2.0; = 0.03) scores in restored patients compared with kyphotic patients. The length of fusion construct in patients grouped by preoperative cervical alignment had no significant impact on the clinical outcomes on regression analysis.
Significantly greater PCS-12 and VAS arm improvement were seen in patients whose cervical sagittal alignment was restored to neutral/lordotic compared with those who remained kyphotic. Multivariate analysis demonstrated no association between construct length and perioperative outcomes.
The results of this study highlight the importance of sagittal alignment and restoration of CL after short-segment ACDF. Irrespective of preoperative sagittal alignment, the length of ACDF fusion construct does not have a significant impact on clinical outcomes.
外科医生已详细研究了颈椎前路椎间盘切除融合术（ACDF）后脊柱排列情况及其对改善临床疗效的影响。本研究的主要分析考察了围手术期颈椎前凸（CL）变化与ACDF术后健康相关生活质量（HRQOL）结果之间的关系。次要分析评估了融合结构长度对根据术前颈椎排列分组的患者预后的影响。
对一个机构数据库进行了一项回顾性队列研究，纳入接受1至3节段ACDF的患者。术前及末次随访时测量C2-C7的CL。对于主要分析，根据患者围手术期颈椎前凸矫正情况进行分类：（1）后凸；（2）维持；（3）恢复。对于次要分析，根据术前C2-C7的CL对患者进行分类：（1）后凸；（2）中立；（3）前凸。比较各组之间的人口统计学数据及患者报告结局指标的围手术期变化。
共纳入308例患者。维持组、恢复组和后凸组在简明健康调查量表12项身体综合评分变化（ΔPCS-12）（9.0对10.3对1.5；P = 0.04）和手臂疼痛视觉模拟量表评分变化（ΔVAS）（-0.9对-3.8对-0.6；P = 0.03）方面存在显著差异。回归分析显示，与后凸患者相比，恢复患者的PCS-12（β：8.6；P = 0.03）和VAS手臂评分（β：-2.0；P = 0.03）改善更为显著。根据术前颈椎排列分组的患者中，融合结构长度在回归分析中对临床疗效无显著影响。
与仍为后凸的患者相比，颈椎矢状面排列恢复至中立/前凸的患者在PCS-12和VAS手臂评分方面改善更为显著。多变量分析显示结构长度与围手术期结局之间无关联。
本研究结果突出了短节段ACDF后矢状面排列及CL恢复的重要性。无论术前矢状面排列如何，ACDF融合结构的长度对临床疗效均无显著影响。
