Pettersson Samuel D, Skrzypkowska Paulina, Ali Shan, Szmuda Tomasz, Krakowiak Michał, Počivavšek Tadej, Sunesson Fanny, Fercho Justyna, Miękisiak Grzegorz
1Neurosurgery Department, Medical University of Gdansk, Poland.
2Neurology Department, Mayo Clinic, Jacksonville, Florida; and.
J Neurosurg Spine. 2022 Sep 2;38(1):4-13. doi: 10.3171/2022.4.SPINE22182. Print 2023 Jan 1.
Laminoplasty is a common treatment for cervical spondylotic myelopathy (CSM) and for ossification of the posterior longitudinal ligament (OPLL). However, approximately 21% of patients undergoing laminoplasty develop cervical kyphotic deformity (KD). Because of the high prevalence rate of KD, several studies have sought to identify predictors for this complication, but the findings remain highly inconsistent. Therefore, the authors performed a systematic review and meta-analysis to establish reliable preoperative predictors of KD.
PubMed, Scopus, and Web of Science databases were used to systematically extract potential references. The first phase of screening required the studies to be written in the English language, involve patients treated for CSM and/or OPLL via laminoplasty, and report postoperative cervical KD. The second phase required the studies to provide more than 10 patients and include a control group. The mean difference (MD) and odds ratio (OR) were calculated for continuous and dichotomous parameters. Study quality was evaluated using the Newcastle-Ottawa Scale. CSM and OPLL patients were further assessed by performing subgroup analyses.
Thirteen studies comprising patients who developed cervical KD (n = 296) and no KD (n = 1254) after receiving cervical laminoplasty for CSM or OPLL were included in the meta-analysis. All studies were retrospective cohorts and were rated as high quality. In the combined univariate analysis of CSM and OPLL patients undergoing laminoplasty, statistically significant predictors for postoperative KD included age (MD 2.22, 95% CI 0.16-4.27, p = 0.03), preoperative BMI (MD 0.85, 95% CI 0.06-1.63, p = 0.04), preoperative C2-7 range of flexion (MD 10.42, 95% Cl 4.24-16.59, p = 0.0009), preoperative C2-7 range of extension (MD -4.59, 95% CI -6.34 to -2.83, p < 0.00001), and preoperative center of gravity of the head to the C7 sagittal vertical axis (MD 26.83, 95% CI 9.13-44.52, p = 0.003). Additionally, among CSM patients, males were identified as having a greater risk for postoperative KD (OR 1.73, 95% CI 1.02-2.93, p = 0.04).
The findings from this study currently provide the largest and most reliable review on preoperative predictors for cervical KD after laminoplasty. Given that several of the included studies identified optimal cutoff points for the variables that are significantly associated with KD, further investigation into the development of a preoperative risk scoring system that can accurately predict KD in the clinical setting is encouraged. PROSPERO registration no.: CRD42022299795 (https://www.crd.york.ac.uk/PROSPERO/).
椎板成形术是治疗脊髓型颈椎病（CSM）和后纵韧带骨化症（OPLL）的常用方法。然而，接受椎板成形术的患者中约有21%会出现颈椎后凸畸形（KD）。由于KD的发生率较高，多项研究试图找出该并发症的预测因素，但研究结果仍高度不一致。因此，作者进行了一项系统评价和荟萃分析，以确定KD可靠的术前预测因素。
使用PubMed、Scopus和Web of Science数据库系统提取潜在参考文献。筛选的第一阶段要求研究用英文撰写，纳入接受椎板成形术治疗CSM和/或OPLL的患者，并报告术后颈椎KD情况。第二阶段要求研究提供超过10例患者并包括一个对照组。对连续和二分参数计算平均差（MD）和比值比（OR）。使用纽卡斯尔-渥太华量表评估研究质量。通过进行亚组分析对CSM和OPLL患者进一步评估。
荟萃分析纳入了13项研究，这些研究的患者在接受CSM或OPLL颈椎椎板成形术后出现颈椎KD（n = 296）和未出现KD（n = 1254）。所有研究均为回顾性队列研究，质量评级为高。在接受椎板成形术的CSM和OPLL患者的联合单因素分析中，术后KD的统计学显著预测因素包括年龄（MD 2.22，95%CI 0.16 - 4.27，p = 0.03）、术前体重指数（MD 0.85，95%CI 0.06 - 1.63，p = 0.04）、术前C2 - 7屈曲范围（MD 10.42，95%Cl 4.24 - 16.59，p = 0.0009）、术前C2 - 7伸展范围（MD -4.59，95%CI -6.34至-2.83，p < 0.00001）以及术前头部重心至C7矢状垂直轴的距离（MD 26.83，95%CI 9.13 - 44.52，p = 0.003）。此外，在CSM患者中，男性被确定为术后KD风险更高（OR 1.73，95%CI 1.02 - 2.93，p = 0.04）。
本研究结果目前为椎板成形术后颈椎KD的术前预测因素提供了最大规模且最可靠的综述。鉴于部分纳入研究确定了与KD显著相关变量的最佳截断点，鼓励进一步研究开发一种可在临床环境中准确预测KD的术前风险评分系统。PROSPERO注册号：CRD42022299795（https://www.crd.york.ac.uk/PROSPERO/）
