Long Connor C, Dugan John E, Chanbour Hani, Chen Jeffrey W, Younus Iyan, Jonzzon Soren, Khan Inamullah, Terry Douglas P, Pennings Jacqueline S, Lugo-Pico Julian, Gardocki Raymond J, Abtahi Amir M, Stephens Byron F, Zuckerman Scott L
Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN.
Department of Neurological Surgery, Baylor College of Medicine, Houston, TX.
Clin Spine Surg. 2025 Feb 1;38(1):E45-E52. doi: 10.1097/BSD.0000000000001646. Epub 2024 May 30.
This is a retrospective cohort study.
In patients undergoing elective posterior cervical laminectomy and fusion (PCLF) with a minimum of 5-year follow-up, we sought to compare reoperation rates between patients with an upper instrumented vertebra (UIV) of C2 versus C3/4.
The long-term outcomes of choosing between C2 versus C3/4 as the UIV in PCLF remain unclear.
A single-institution, retrospective cohort study from a prospective registry was conducted of patients undergoing elective, degenerative PCLF from December 2010 to June 2018. The primary exposure was UIV of C2 versus C3/4. The primary outcome was reoperation. Multivariable logistic regression controlled for age, smoking, diabetes, and fusion to the thoracic spine.
Of the 68 patients who underwent PCLF with 5-year follow-up, 27(39.7%) had a UIV of C2, and 41(60.3%) had a UIV of either C3/4. Groups had similar duration of symptoms ( P =0.743), comorbidities ( P >0.999), and rates of instrumentation to the thoracic spine (70.4% vs. 53.7%, P =0.210). The C2 group had significantly longer operative time (231.8±65.9 vs. 181.6±44.1 mins, P <0.001) and more fused segments (5.9±1.8 vs. 4.2±0.9, P <0.001). Reoperation rate was lower in the C2 group compared with C3/4 (7.4% vs. 19.5%), though this did not reach statistical significance ( P =0.294). Multivariable logistic regression showed increased odds of reoperation for the C3/4 group compared with the C2 group (OR=3.29, 95%CI=0.59-18.11, P =0.170), though statistical significance was not reached. Similarly, the C2 group had a lower rate of instrumentation failure (7.4% vs. 12.2%, P =0.694) and adjacent segment disease/disk herniation (0% vs. 7.3%, P =0.271), though neither trend attained statistical significance.
Patients with a UIV of C2 had less than half the number of reoperations and less adjacent segment disease, though neither trend was statistically significant. Despite a lack of statistical significance, whether a clinically meaningful difference exists between UIV of C2 versus C3/4 should be validated in larger samples with long-term follow-up.
Level-3.
这是一项回顾性队列研究。
在接受择期颈椎后路椎板切除融合术（PCLF）且随访至少5年的患者中，我们试图比较C2作为上位固定椎（UIV）与C3/4作为UIV的患者再次手术率。
在PCLF中选择C2还是C3/4作为UIV的长期结果尚不清楚。
对2010年12月至2018年6月接受择期退行性PCLF的患者进行了一项单机构、基于前瞻性登记的回顾性队列研究。主要暴露因素是C2作为UIV与C3/4作为UIV。主要结局是再次手术。多变量逻辑回归分析控制了年龄、吸烟、糖尿病以及与胸椎融合的情况。
在68例接受PCLF且随访5年的患者中，27例（39.7%）的UIV为C2，41例（60.3%）的UIV为C3/4。两组患者症状持续时间相似（P = 0.743），合并症情况相似（P > 0.999），与胸椎融合的比例相似（70.4%对53.7%，P = 0.210）。C2组手术时间明显更长（231.8±65.9分钟对181.6±44.1分钟，P < 0.001），融合节段更多（5.9±1.8对4.2±0.9，P < 0.001）。C2组的再次手术率低于C3/4组（7.4%对19.5%），尽管未达到统计学显著性（P = 0.294）。多变量逻辑回归分析显示，与C2组相比，C3/4组再次手术的几率增加（OR = 3.29，95%CI = 0.59 - 18.11，P = 0.170），但未达到统计学显著性。同样，C2组器械失败率较低（7.4%对12.2%，P = 0.694），相邻节段疾病/椎间盘突出发生率较低（0%对7.3%，P = 0.271），但两种趋势均未达到统计学显著性。
UIV为C2的患者再次手术次数不到C3/4组的一半，相邻节段疾病也较少，尽管两种趋势均无统计学显著性。尽管缺乏统计学显著性，但C2作为UIV与C3/4作为UIV之间是否存在临床意义上的差异应在更大样本且长期随访中进行验证。
3级。
