Departments of Orthopaedic and Neurological Surgery, NYU Langone Orthopedic Hospital, New York, NY.
New York Spine Institute, New York, NY.
Spine (Phila Pa 1976). 2024 Jan 15;49(2):116-127. doi: 10.1097/BRS.0000000000004843. Epub 2023 Oct 5.
STUDY DESIGN/SETTING: Retrospective single-center study.
The global alignment and proportion score is widely used in adult spinal deformity surgery. However, it is not specific to the parameters used in adult cervical deformity (ACD).
Create a cervicothoracic alignment and proportion (CAP) score in patients with operative ACD.
Patients with ACD with 2-year data were included. Parameters consisted of relative McGregor's Slope [RMGS = (MGS × 1.5)/0.9], relative cervical lordosis [RCL = CL - thoracic kyphosis (TK)], Cervical Lordosis Distribution Index (CLDI = C2 - Apex × 100/C2 - T2), relative pelvic version (RPV = sacral slope - pelvic incidence × 0.59 + 9), and a frailty factor (greater than 0.33). Cutoff points were chosen where the cross-tabulation of parameter subgroups reached a maximal rate of meeting the Optimal Outcome. The optimal outcome was defined as meeting Good Clinical Outcome criteria without the occurrence of distal junctional failure (DJF) or reoperation. CAP was scored between 0 and 13 and categorized accordingly: ≤3 (proportioned), 4-6 (moderately disproportioned), >6 (severely disproportioned). Multivariable logistic regression analysis determined the relationship between CAP categories, overall score, and development of distal junctional kyphosis (DJK), DJF, reoperation, and Optimal Outcome by 2 years.
One hundred five patients with operative ACD were included. Assessment of the 3-month CAP score found a mean of 5.2/13 possible points. 22.7% of patients were proportioned, 49.5% moderately disproportioned, and 27.8% severely disproportioned. DJK occurred in 34.5% and DJF in 8.7%, 20.0% underwent reoperation, and 55.7% achieved Optimal Outcome. Patients severely disproportioned in CAP had higher odds of DJK [OR: 6.0 (2.1-17.7); P =0.001], DJF [OR: 9.7 (1.8-51.8); P =0.008], reoperation [OR: 3.3 (1.9-10.6); P =0.011], and lower odds of meeting the optimal outcome [OR: 0.3 (0.1-0.7); P =0.007] by 2 years, while proportioned patients suffered zero occurrences of DJK or DJF.
The regional alignment and proportion score is a method of analyzing the cervical spine relative to global alignment and demonstrates the importance of maintaining horizontal gaze, while also matching overall cervical and thoracolumbar alignment to limit complications and maximize clinical improvement.
研究设计/设置：回顾性单中心研究。
全球对齐和比例评分广泛应用于成人脊柱畸形手术中。然而，它并不特定于成人颈椎畸形（ACD）中使用的参数。
为 ACD 患者创建颈椎-胸椎对齐和比例（CAP）评分。
纳入 ACD 患者，随访时间 2 年。参数包括相对 McGregor 斜率[RMGS=（MGS×1.5）/0.9]、相对颈椎前凸[RCL=CL-胸椎后凸（TK）]、颈椎前凸分布指数（CLDI=C2-顶点×100/C2-T2）、相对骨盆版本[RPV=骶骨斜率-骨盆入射角×0.59+9]和脆弱因素（大于 0.33）。选择参数亚组的交叉列表达到最佳结果的最大比率的截点。最佳结果定义为符合良好临床结果标准，且无远端交界性失败（DJF）或再次手术。CAP 评分为 0 至 13 分，并相应分类：≤3（成比例）、4-6（中度不成比例）、>6（严重不成比例）。多变量逻辑回归分析确定了 CAP 分类、总评分以及 DJK、DJF、再次手术和 2 年时的最佳结果之间的关系。
纳入 105 例接受手术治疗的 ACD 患者。3 个月时 CAP 评分平均为 13 分中的 5.2 分。22.7%的患者成比例，49.5%中度不成比例，27.8%严重不成比例。DJK 发生率为 34.5%，DJF 发生率为 8.7%，20.0%患者接受再次手术，55.7%达到最佳结果。CAP 严重不成比例的患者 DJK 的可能性更高[比值比（OR）：6.0（2.1-17.7）；P=0.001]、DJF（OR：9.7（1.8-51.8）；P=0.008）、再次手术（OR：3.3（1.9-10.6）；P=0.011），且 2 年内达到最佳结果的可能性较低[OR：0.3（0.1-0.7）；P=0.007]，而成比例患者 DJK 或 DJF 发生率为零。
区域性对齐和比例评分是一种分析颈椎相对于整体对齐的方法，它表明保持水平注视的重要性，同时还需要匹配整个颈椎和胸腰椎的对齐，以限制并发症并最大限度地提高临床改善。
