Du Wei, Wang Hai-Xu, Zhang Jing-Tao, Wang Feng, Zhang Xu, Shen Yong, Chen Rong, Zhang Li
Department of Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, China.
Department of Neurology, Hebei Key Laboratory of Vascular Homeostasis, Hebei Collaborative Innovation Center for Cardio-Cerebrovascular Disease, The Second Hospital of Hebei Medical University, Shijiazhuang, China.
Front Neurosci. 2022 Nov 23;16:1029327. doi: 10.3389/fnins.2022.1029327. eCollection 2022.
Cervical kyphosis is a common but potentially debilitating and challenging condition. There is controversy on the optimal surgical strategy for the treatment of kyphotic cervical spondylotic myelopathy (KCSM) using either anterior approach or posterior approach.
The purpose of this study was to investigate the surgical efficacy of anterior decompression with fusion (ADF) vs. posterior decompression with fixation (PDF) for the treatment of KCSM, and to further analyze the changes of cervical spinal alignment parameters and axial symptoms (AS) severity after kyphotic correction.
We retrospectively reviewed 117 patients with KCSM who had undergone ADF (58 patients) and PDF (59 patients) between January 2016 and December 2020. Cervical spinal alignment parameters, including curvature index (CI) and C2-7 Cobb angle, were measured on the PreOP and PostOP lateral radiographs. Recovery rate was calculated based on the Japanese Orthopedic Association (JOA) score. AS severity was quantified by Neck Disability Index (NDI). A -value less than 0.05 was considered to be significant.
The patient mean age, gender, presenting symptoms and follow-up time were similar between the two groups ( > 0.05). However, there were statistically significant differences ( < 0.001) between the two groups regarding the operation levels, operating time and intraoperative blood loss. Analysis of PostOP follow-up data showed significant differences ( < 0.001) in CI, correction of CI, C2-7 Cobb angle, and NDI between the two groups, whereas no significant differences in JOA score ( = 0.16) and recovery rate ( = 0.14). There were significant differences ( < 0.001) in CI, C2-7 Cobb angle, JOA score, and NDI between PreOP and PostOP follow-up in each group. Correction of CI showed positive correlation with recovery of NDI in Group ADF ( = 0.51, < 0.001), and in Group PDF ( = 0.45, < 0.001).
Satisfied neurological improvement was obtained by ADF and PDF for patients with KCSM. Cervical kyphotic correction caused significant improvement of AS, and was more favorable with ADF than with PDF. Surgeons should pay full consideration of the merits and shortcomings of each approach when deciding on a surgical plan.
颈椎后凸是一种常见但可能使人衰弱且具有挑战性的病症。对于采用前路或后路治疗后凸型颈椎病性脊髓病（KCSM）的最佳手术策略存在争议。
本研究的目的是探讨前路减压融合术（ADF）与后路减压固定术（PDF）治疗KCSM的手术疗效，并进一步分析后凸矫正后颈椎排列参数和轴性症状（AS）严重程度的变化。
我们回顾性分析了2016年1月至2020年12月期间接受ADF（58例患者）和PDF（59例患者）治疗的117例KCSM患者。在术前和术后的侧位X线片上测量颈椎排列参数，包括曲度指数（CI）和C2-7 Cobb角。根据日本骨科协会（JOA）评分计算恢复率。AS严重程度通过颈部残疾指数（NDI）进行量化。P值小于0.05被认为具有统计学意义。
两组患者的平均年龄、性别、出现的症状和随访时间相似（P>0.05）。然而，两组在手术节段、手术时间和术中出血量方面存在统计学显著差异（P<0.001）。对术后随访数据的分析显示，两组在CI、CI矫正、C2-7 Cobb角和NDI方面存在显著差异（P<0.001），而在JOA评分（P = 0.16）和恢复率（P = 0.14）方面无显著差异。每组术前和术后随访的CI、C2-7 Cobb角、JOA评分和NDI均存在显著差异（P<0.001）。ADF组中CI矫正与NDI恢复呈正相关（r = 0.51，P<0.001），PDF组中（r = 0.45，P<0.001）。
ADF和PDF治疗KCSM患者均获得了满意的神经功能改善。颈椎后凸矫正使AS得到显著改善，且ADF比PDF更有利。外科医生在制定手术方案时应充分考虑每种方法的优缺点。
