Algarni Nizar, Dea Nicolas, Evaniew Nathan, McIntosh Greg, Jacobs Bradley W, Paquet Jérome, Wilson Jefferson R, Hall Hamilton, Bailey Christopher S, Weber Michael H, Nataraj Andrew, Attabib Najmedden, Rampersaud Y Raja, Cadotte David W, Stratton Alexandra, Christie Sean D, Fisher Charles G, Charest-Morin Raphaële
Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedics Surgery, University of British Columbia, Vancouver BC, Canada.
Global Spine J. 2024 Sep;14(7):2062-2073. doi: 10.1177/21925682231166605. Epub 2023 Mar 24.
Retrospective cohort study.
The primary objective was to evaluate the impact of the upper instrumented level (UIV) being at C2 vs C3 in posterior cervical construct on patient reported outcomes (PROs) up to 24 months after surgery for cervical degenerative myelopathy (DCM). Secondary objectives were to compare operative time, intra-operative blood loss (IOBL), length of stay (LOS), adverse events (AEs) and re-operation.
Patients who underwent a posterior cervical instrumented fusion (3 and + levels) with a C2 or C3 UIV, with 24 months follow-up were analyzed. PROs (NDI, EQ5D, SF-12 PCS/MCS, NRS arm/neck pain) were compared using ANCOVA. Operative duration, IOBL, AEs, and re-operation were compared. Subgroup analysis was performed on patient presenting with pre-operative malalignment (cervical sagittal vertical axis ≥40 mm and/or T1slope- cervical lordosis >15°).
173 patients were included, of which 41 (24%) had a C2 UIV and 132 (76%) a C3 UIV. There was no statistically significant difference between the groups for the changes in PROs up to 24 months. Subgroup analysis of patients with pre-operative malalignment showed a trend towards greater improvement in the NDI at 12 months with a C2 UIV ( = .054). Operative time, IOBL and peri-operative AEs were more in C2 group ( < .05). There was no significant difference in LOS and re-operation ( > .05).
In this observational study, up to 24 months after surgery for posterior cervical fusion in DCM greater than 3 levels, PROs appear to evolve similarly.
回顾性队列研究。
主要目的是评估颈椎后路手术中C2与C3作为上固定节段（UIV）对颈椎退行性脊髓病（DCM）患者术后长达24个月的患者报告结局（PROs）的影响。次要目的是比较手术时间、术中失血量（IOBL）、住院时间（LOS）、不良事件（AEs）和再次手术情况。
分析接受后路颈椎内固定融合术（3个及以上节段）且UIV为C2或C3并随访24个月的患者。使用协方差分析比较PROs（NDI、EQ5D、SF - 12身体/精神健康评分量表、NRS手臂/颈部疼痛评分）。比较手术持续时间、IOBL、AEs和再次手术情况。对术前存在排列不齐（颈椎矢状垂直轴≥40mm和/或T1斜率 - 颈椎前凸>15°）的患者进行亚组分析。
纳入173例患者，其中41例（24%）UIV为C2，132例（76%）UIV为C3。两组在术后长达24个月的PROs变化方面无统计学显著差异。术前存在排列不齐患者的亚组分析显示，C2作为UIV时，12个月时NDI有更大改善的趋势（P = 0.054）。C2组的手术时间、IOBL和围手术期AEs更多（P < 0.05）。LOS和再次手术情况无显著差异（P > 0.05）。
在这项观察性研究中，对于DCM超过3节段的颈椎后路融合术后长达24个月，PROs似乎有相似的变化。
