Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Naval Military Medical University (Second Military Medical University), Shanghai, People's Republic of China.
Department of Orthopedics, The 72nd Army Hospital of the People's Liberation Army, Huzhou, People's Republic of China.
Orthop Surg. 2024 Jun;16(6):1407-1417. doi: 10.1111/os.14048. Epub 2024 May 7.
Focal cervical kyphotic deformity (FCK) without neurologic compression is not uncommon in patients with cervical spondylotic myelopathy (CSM) who underwent anterior cervical decompression and fusion (ACDF) surgery. It remains unclear whether FCK at non-responsible levels needs to be treated simultaneously. This study aims to investigate whether FCK at non-responsible levels is the prognostic factor for CSM and elucidate the surgical indication for FCK.
Patients with CSM who underwent ACDF between January 2016 and April 2021 were included. Patients were divided into two groups according to the presence of FCK and two classifications according to global cervical sagittal alignment. Clinical outcomes were compared using Japanese Orthopaedic Association (JOA) scores and recovery rate (RR) of neurologic function. Univariate and multivariate analysis based on RR assessed the relationship between various possible prognostic factors and clinical outcomes. The receiver operating characteristic curve (ROC) was used to determine the optimal cutoff value of the focal Cobb angle to predict poor clinical outcomes.
A total of 94 patients were included, 41 with FCK and 53 without. Overall, the RR of neurologic function was significantly lower in the FCK than in the non-FCK group. Further analysis showed that the RR difference between the two groups was only observed in hypo-lordosis classification (kyphotic and sigmoid alignment), but not in the lordosis classification. Multivariate analysis showed that the preoperative focal Cobb angle in the FCK level (OR = 0.42; 95% CI = 0.18-0.97) was independently associated with clinical outcomes in the hypo-lordosis classification. The optimal cutoff point of the preoperative focal kyphotic Cobb angle was calculated at 4.05°.
For CSM with hypo-lordosis, FCK was a risk factor for poor postoperative outcomes. Surgeons may consider treating the FCK simultaneously if the focal kyphotic Cobb angle of FCK is greater than 4.05° and is accompanied by cervical global kyphotic or sigmoid deformity.
在接受颈椎前路减压融合术（ACDF）的颈椎病脊髓病（CSM）患者中，无神经压迫的局灶性颈椎后凸畸形（FCK）并不少见。目前尚不清楚非责任节段的 FCK 是否需要同时治疗。本研究旨在探讨非责任节段的 FCK 是否是 CSM 的预后因素，并阐明 FCK 的手术适应证。
纳入 2016 年 1 月至 2021 年 4 月接受 ACDF 的 CSM 患者。根据是否存在 FCK 将患者分为两组，并根据整体颈椎矢状位排列分为两类。使用日本矫形协会（JOA）评分和神经功能恢复率（RR）比较临床结果。基于 RR 的单变量和多变量分析评估了各种可能的预后因素与临床结果之间的关系。使用受试者工作特征曲线（ROC）确定预测临床结局不良的局灶 Cobb 角的最佳截断值。
共纳入 94 例患者，其中 41 例存在 FCK，53 例不存在。总体而言，FCK 组的神经功能 RR 明显低于非 FCK 组。进一步分析表明，两组之间的 RR 差异仅在低拱度分类（后凸和矢状位）中观察到，而在拱度分类中则没有观察到。多变量分析显示，FCK 水平的术前局灶 Cobb 角（OR=0.42；95%CI=0.18-0.97）与低拱度分类的临床结果独立相关。术前局灶性后凸 Cobb 角的最佳截断点计算为 4.05°。
对于低拱度的 CSM，FCK 是术后结局不良的危险因素。如果 FCK 的局灶性后凸 Cobb 角大于 4.05°且伴有颈椎整体后凸或矢状位畸形，外科医生可能会考虑同时治疗 FCK。
