Bunmaprasert Torphong, Keeratiruangrong Jakkrit, Lee Sang Hun, Sugandhavesa Nantawit, Liawrungrueang Wongthawat
Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Department of Orthopaedic Surgery, Johns Hopkins School of Medicine, Baltimore, USA.
J Spine Surg. 2024 Mar 20;10(1):109-119. doi: 10.21037/jss-23-107. Epub 2024 Mar 15.
Adult spinal deformity, especially sagittal imbalance, is affecting health-related quality-of-life (HRQOL) scores. There is a lack of emphasis in the comparison of cervical sagittal parameters in patients with degenerative cervical spondylolisthesis and degenerative cervical kyphosis. The aim of study is to determine the preoperative and postoperative cervical sagittal parameters in myeloradiculopathic patients with degenerative cervical spondylolisthesis and degenerative cervical kyphosis treated by anterior cervical discectomy and fusion (ACDF).
A retrospective medical records and radiographic study of 30 adult patients were reviewed. Fifteen patients with degenerative cervical spondylolisthesis and 15 patients with degenerative cervical kyphosis have been performed ACDF from 2010-2020. We measured the preoperative and postoperative cervical sagittal parameters: C0-C2 angle, C1-C2 angle, C2-C7 angle, C2-C7 sagittal vertical axis (SVA), T1 slope, neck tilt angle and thoracic inlet angle. Minimum follow-up period was at least 2 years.
Patients in degenerative cervical kyphosis group have C2-C7 angle less than degenerative cervical spondylolisthesis group (-14.88±7.32 9.60±13.60), leading to increase the mismatch between T1 slope and C2-C7 angle in kyphotic group and hyperlordosis of C0-C2 angle and C1-C2 angle (31.13±7.68, 37.88±5.08) compare with spondylolisthesis group (13±10.20, 24.60±10.70). Whereas patients with degenerative cervical spondylolisthesis have C2-C7 SVA (33.22±13.92) more than kyphosis group (13.70±13.60). After surgery, there is significant increase of the C2-C7 angle in the kyphosis group compare before and after surgery (-14.88±7.32 4.10±11.80). While the spondylolisthesis group has no significantly different parameters compare to before surgery. However, the postoperative cervical sagittal parameters of all patients are within the normal thresholds (T1-Slope minus C2-C7 lordosis <15° and C2-C7 SVA <40 mm).
The study demonstrates the difference of sagittal parameters between degenerative cervical spondylolisthesis and kyphosis before and after surgery. ACDF not only provides neural decompressive procedure, but also corrects the regional cervical sagittal parameters.
成人脊柱畸形，尤其是矢状面失衡，会影响健康相关生活质量（HRQOL）评分。在退变性颈椎滑脱症和退变性颈椎后凸症患者的颈椎矢状面参数比较方面，目前缺乏足够的关注。本研究的目的是确定接受前路颈椎间盘切除融合术（ACDF）治疗的脊髓神经根型退变性颈椎滑脱症和退变性颈椎后凸症患者术前和术后的颈椎矢状面参数。
回顾性分析30例成年患者的病历和影像学资料。2010年至2020年期间，对15例退变性颈椎滑脱症患者和15例退变性颈椎后凸症患者进行了ACDF手术。我们测量了术前和术后的颈椎矢状面参数：C0-C2角、C1-C2角、C2-C7角、C2-C7矢状垂直轴（SVA）、T1斜率、颈部倾斜角和胸廓入口角。最短随访期至少为2年。
退变性颈椎后凸症组患者的C2-C7角小于退变性颈椎滑脱症组（-14.88±7.32对9.60±13.60），导致后凸组T1斜率与C2-C7角之间的不匹配增加，且C0-C2角和C（1-C2角出现过度前凸（31.13±7.68，37.88±5.08），而滑脱组分别为13±10.20和24.60±10.70）。然而，退变性颈椎滑脱症患者的C2-C7 SVA（33.22±13.92）大于后凸症组（13.70±13.60）。手术后,后凸症组C2-C7角较手术前后有显著增加（-14.88±7.32对4.10±11.80）。而滑脱组与手术前相比参数无显著差异。然而，所有患者术后的颈椎矢状面参数均在正常阈值范围内（T1斜率减去C2-C7前凸<15°且C2-C7 SVA<40mm）。
本研究证明了退变性颈椎滑脱症和后凸症手术前后矢状面参数的差异。ACDF不仅提供了神经减压手术，还纠正了局部颈椎矢状面参数。
