Department of Orthopedics, West China Hospital, Sichuan University, #37 Guoxue Alley, Wuhou District, Chengdu, Sichuan Province, People's Republic of China.
BMC Musculoskelet Disord. 2022 Aug 3;23(1):741. doi: 10.1186/s12891-022-05705-y.
The purpose of this study is to explore: 1) whether the extent of facet joint distraction affects functional outcomes following single-level anterior cervical disc replacement (ACDR) for cervical spondylotic radiculopathy and 2) whether the extent of facet joint distraction correlates with the cervical sagittal parameters.
We performed a retrospective analysis on 70 patients who had undergone a single-level ACDR to treat cervical spondylotic radiculopathy between January 2014 and December 2018. Pre- and post-operative lateral cervical spine X-ray radiographs were collected to determine radiographic parameters, including C0-C2 angle, C2-C7 angle, C7 Slope (C7S), T1 Slope (T1S), C2-C7 sagittal vertical axis (SVA), C2-C7 range of motion (ROM), Segmental ROM, disc height (DH) and inter-facet distance (ID). And the extend of facet joint distraction was evaluated by the two indexes: degree of intervertebral distraction (DID) defined and degree of facet joint distraction (DFJD). The visual analog scale (VAS) and the Neck Disability Index scores (NDI) were adopted to demonstrate functional outcomes. Patients with the functional outcome improvement below the average were set as the positive group in the receiver operating characteristic (ROC) curve analysis, to find an optimal cut-off value of extent of facet joint distraction.
VAS and NDI scores improved significantly from pre- to post-operation among the entire cohort, and DFJD had a statistically significant negative correlation with ΔVAS (p < 0.001) and ΔNDI (p < 0.001). According to ROC curve analysis, the cut-off value of DFJD for differing the appropriate and excessive distraction groups was set at 29.16% (sensitivity = 70.73%, specificity = 67.86%). Between these two groups, the ΔT1S, ΔROM, ΔVAS, and ΔNDI were significantly different (p < 0.05).
Single-segment ACDR may improve the functional outcome of patients with cervical spondylotic radiculopathy. However, those whose DFJD was greater than 29.16% had worse VAS and NDI scores, as well as a lower ΔT1S and a lower ΔROM.
本研究旨在探讨：1）关节突关节撑开程度是否会影响单节段前路颈椎间盘置换术（ACDR）治疗神经根型颈椎病的功能结果，2）关节突关节撑开程度是否与颈椎矢状参数相关。
我们对 2014 年 1 月至 2018 年 12 月期间接受单节段 ACDR 治疗神经根型颈椎病的 70 例患者进行了回顾性分析。收集术前和术后颈椎侧位 X 线片，以确定影像学参数，包括 C0-C2 角、C2-C7 角、C7 斜率（C7S）、T1 斜率（T1S）、C2-C7 矢状垂直轴（C2-C7SVA）、C2-C7 活动度（ROM）、节段 ROM、椎间盘高度（DH）和关节突关节间隙（ID）。通过两个指标评估关节突关节撑开程度：定义的椎间撑开度（DID）和关节突关节撑开度（DFJD）。视觉模拟评分（VAS）和颈部残疾指数（NDI）用于评估功能结果。将功能结果改善低于平均值的患者设为受试者工作特征（ROC）曲线分析中的阳性组，以找到关节突关节撑开程度的最佳截断值。
整个队列中，VAS 和 NDI 评分从术前到术后均显著改善，DFJD 与ΔVAS（p<0.001）和ΔNDI（p<0.001）呈显著负相关。根据 ROC 曲线分析，DFJD 区分适当和过度撑开组的截断值设定为 29.16%（灵敏度=70.73%，特异性=67.86%）。在这两组之间，ΔT1S、ΔROM、ΔVAS 和ΔNDI 差异有统计学意义（p<0.05）。
单节段 ACDR 可改善神经根型颈椎病患者的功能结果。然而，DFJD 大于 29.16%的患者 VAS 和 NDI 评分较差，T1S 和 ROM 降低。
