Pouleau Henri-Benjamin, De Witte Olivier, Dhaene Benjamin, Jodaïtis Alexandre
University Hospital Center Tivoli, La Louvière, Department of Neurosurgery, Belgium.
Academic Hospital Center Erasme, Bruxelles, Department of Neurosurgery, Belgium.
Brain Spine. 2023 Jun 12;3:101765. doi: 10.1016/j.bas.2023.101765. eCollection 2023.
Severe spondylosis is common and represents contraindication to achieve cervical disc arthroplasty (CDA).
Is it possible to restore cervical sagittal alignment using an adequate prosthetic model and performing systematic bilateral total uncuscectomy (or uncinectomy), even in cases of severe spondylosis ?
We propose a prospective clinical and radiological study comparing the evolution of preoperative and postoperative cervical sagittal balance 1 year after the interposition of a prosthesis with mobile bearing and systematic total uncuscectomy. VAS for brachialgia and cervicalgia, NDI, Odom's criteria, C2-C7 Cobb angle, C2-C7 SVA, T1 slope, C2 slope, C1-C2 Cobb angle, and segmental Cobb angle were analyzed preoperatively and 1 year postoperatively.
73 patients for a total of 129 levels treated were analyzed. Patients showed significant improvements in VASb, VASc, NDI, and Odom's criteria one year after surgery without clinical differences in the severe spondylosis subgroup (41 patients for 77 levels treated). Our results showed an increase in the C2-C7 Cobb angle postoperatively and a better correlation between T1 slope and C2-C7 Cobb angle postoperatively than preoperatively. Postoperative radiological results were similar between the spondylosis and non-spondylosis subgroups. However preoperative C2-C7 Cobb angle and preoperative ROM were lower in the severe spondylosis subgroup.
This study showed the possibility of restoring cervical sagittal balance by performing cervical disc arthroplasty with systematic uncuscectomy, even in cases of severe spondylosis. Moreover, we propose a simplified mathematical formula to preoperatively evaluate the lack of angulation to restore sagittal cervical alignment.
严重的脊柱关节病很常见，是颈椎间盘置换术（CDA）的禁忌证。
即使在严重脊柱关节病的病例中，使用合适的假体模型并进行系统性双侧全钩突切除术（或钩突切除术），是否有可能恢复颈椎矢状位对线？
我们进行了一项前瞻性临床和影像学研究，比较了植入活动轴承假体并进行系统性全钩突切除术后1年颈椎矢状位平衡的术前和术后演变情况。分析了术前和术后1年的臂痛和颈痛视觉模拟评分（VAS）、颈部功能障碍指数（NDI）、奥多姆标准、C2-C7 Cobb角、C2-C7矢状垂直轴（SVA）、T1斜率、C2斜率、C1-C2 Cobb角和节段性Cobb角。
共分析了73例患者的129个治疗节段。患者术后1年VASb、VASc、NDI和奥多姆标准均有显著改善，严重脊柱关节病亚组（41例患者，77个治疗节段）无临床差异。我们的结果显示术后C2-C7 Cobb角增加，且术后T1斜率与C2-C7 Cobb角之间的相关性比术前更好。脊柱关节病亚组和非脊柱关节病亚组的术后影像学结果相似。然而，严重脊柱关节病亚组的术前C2-C7 Cobb角和术前活动度较低。
本研究表明，即使在严重脊柱关节病的病例中，通过进行系统性钩突切除的颈椎间盘置换术恢复颈椎矢状位平衡是有可能的。此外，我们提出了一个简化的数学公式，用于术前评估恢复颈椎矢状位对线所需的角度缺失。
