Departments of Orthopaedic and Neurological Surgery, NYU Langone Orthopaedic Hospital; New York Spine Institute, New York, NY.
Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital, New York, NY.
Clin Spine Surg. 2023 Apr 1;36(3):106-111. doi: 10.1097/BSD.0000000000001442. Epub 2023 Mar 13.
Retrospective cohort study.
Construct an individualized cervical realignment strategy based on patient parameters at the presentation that results in superior 2-year health-related quality of life metrics and decreased rates of junctional failure and reoperation following adult cervical deformity surgery.
Research has previously focused on adult cervical deformity realignment thresholds for maximizing clinical outcomes while minimizing complications. However, realignment strategies may differ based on patient presentation and clinical characteristics.
We included adult cervical deformity patients with 2-year data. The optimal outcome was defined as meeting good clinical outcomes without distal junctional failure or reoperation. Radiographic parameters assessed included C2 Slope, C2-C7, McGregor's slope, TS-CL, cSVA, T1 slope, and preoperative lowest-instrumented vertebra (LIV) inclination angle. Conditional inference trees were used to establish thresholds for each parameter based on achieving the optimal outcome. Analysis of Covariance and multivariable logistic regression analysis, controlling for age, comorbidities, baseline deformity and disability, and surgical factors, assessed outcome rates for the hierarchical approach within each deformity group.
One hundred twenty-seven patients were included. After correction, there was a significant difference in meeting the optimal outcome when correcting the C2 slope below 10 degrees (85% vs. 34%, P <0.001), along with lower rates of distal junctional failure (DJF) (7% vs. 42%, P <0.001). Next, after isolating patients below the C2 slope threshold, the selection of LIV with an inclination between 0 and 40 degrees demonstrated lower rates of distal junctional kyphosis and higher odds of meeting optimal outcome(OR: 4.2, P =0.011). The best third step was the correction of cSVA below 35 mm. This hierarchical approach (11% of the cohort) led to significantly lower rates of DJF (0% vs. 15%, P <0.007), reoperation (8% vs. 28%, P <0.001), and higher rates of meeting optimal outcome (93% vs. 36%, P <0.001) when controlling for age, comorbidities, and baseline deformity and disability.
Our results indicate that the correction of C2 slope should be prioritized during cervical deformity surgery, with the selection of a stable LIV and correction of cervical SVA below the idealized threshold. Among the numerous radiographic parameters considered during preoperative planning for cervical deformity correction, our determinations help surgeons prioritize those realignment strategies that maximize the health-related quality of life outcomes and minimize complications.
Level-III.
回顾性队列研究。
基于患者就诊时的参数构建个体化颈椎矫正策略，以获得更好的 2 年健康相关生活质量指标，并降低成人颈椎畸形手术后交界区失败和再次手术的发生率。
既往研究侧重于成人颈椎畸形矫正的临界值，以最大限度地提高临床效果，同时将并发症降至最低。然而，矫正策略可能因患者的表现和临床特征而有所不同。
我们纳入了具有 2 年数据的成人颈椎畸形患者。最佳结果定义为符合良好临床效果，且无远端交界区失败或再次手术。评估的影像学参数包括 C2 斜率、C2-C7、McGregor 斜率、TS-CL、cSVA、T1 斜率和术前最低置钉椎体（LIV）倾斜角度。条件推理树用于根据达到最佳结果为每个参数确定阈值。协方差分析和多变量逻辑回归分析，控制年龄、合并症、基线畸形和残疾以及手术因素，评估了每个畸形组内分层方法的结果发生率。
共纳入 127 例患者。在纠正后，C2 斜率低于 10 度时，达到最佳结果的差异有统计学意义（85%比 34%，P<0.001），远端交界区失败（DJF）的发生率也较低（7%比 42%，P<0.001）。接下来，在将患者分离到 C2 斜率阈值以下后，LIV 倾斜在 0 至 40 度之间的选择显示出较低的远端交界区后凸和更高的达到最佳结果的可能性（比值比：4.2，P=0.011）。最佳的第三步是 cSVA 纠正至低于 35mm。这种分层方法（占队列的 11%）显著降低了 DJF（0%比 15%，P<0.007）、再次手术（8%比 28%，P<0.001）和达到最佳结果的可能性（93%比 36%，P<0.001），同时控制了年龄、合并症和基线畸形和残疾。
我们的结果表明，在颈椎畸形手术中应优先纠正 C2 斜率，选择稳定的 LIV，并将颈椎 SVA 纠正至理想阈值以下。在颈椎畸形矫正术前计划中考虑的众多影像学参数中，我们的确定有助于外科医生优先考虑那些最大限度地提高健康相关生活质量结果并最大限度地减少并发症的矫正策略。
III 级。
