Department of Neurosurgery, Sakarya University Faculty of Medicine, Sakarya, Turkey.
Department of Neurosurgery, Sakarya University Training and Research Hospitaly, Sakarya, Turkey.
Orthop Surg. 2024 Oct;16(10):2410-2418. doi: 10.1111/os.14167. Epub 2024 Jul 23.
For degenerative diseases accompanied by cervical malalignment, the starting and ending points of fixation for better cervical sagittal alignment and clinical results are not as clear as the thoracolumbar region. In this study we aimed to compare the effects of posterior subaxial cervical fixation (PSCF), posterior cervical fixation extending to the upper thoracic region and posterior upper cervical fixation extending to the upper thoracic region on cervical sagittal alignment.
Sixty-three patients who underwent posterior cervical and cervical-up thoracic fixation were retrospectively analyzed in a comparative study. The procedures that we performed from May 2019 to March 2022 on these 63 patients were: (1) C3-C6 group-posterior subaxial cervical fixation; (2) Subaxial-T2 group-posterior subaxial cervicothoracic fixation (PSCTF); (3) C2-T2 upper thoracic posterior fixation group. The C3-C6 group had 27 patients, Subaxial-T2 group had 24, and C2-T2 group had 12. We determined the minimum follow-up period as 12 months. C0-2, C2-7 lordosis angle, sagittal vertical axis (SVA), C2 slope, C7 slope, T1 slope, cervical slope, neck slope, and thoracic inlet angle (TIA) measurements were made in three patient groups. Comparatively, cervical sagittal alignment was evaluated.
In the C2-T2 group, a significant increase in C2-C7 lordosis, decrease in C2 slope, and increase in TS-CL were observed. Significant C2-C7 lordosis decrease, C2 slope increase, and TS-CL decrease were observed in the C3-C6 group. A significant increase in C2-C7 lordosis and a decrease in C2 slope were observed in the subaxial-T2 group. No significant change was observed in the TS-CL angle.
In cervical degenerative disorders accompanied by cervical malalignment, we recommend the C2-T2 fixation method, which provides the desired C2-C7 lordosis, SVA within the normal range, and the best Neck Disability Index results.
对于伴有颈椎失稳的退行性疾病，颈椎矢状位对线的起始和终点固定不如胸腰椎明确。本研究旨在比较下颈椎后路固定（PSCF）、颈椎后路固定延伸至上胸段和颈椎后路固定延伸至上胸段对上颈椎矢状位对线的影响。
回顾性分析 2019 年 5 月至 2022 年 3 月行颈椎后路和颈胸段后路固定的 63 例患者，分为三组：（1）C3-C6 组：下颈椎后路固定；（2）Subaxial-T2 组：下颈椎后路固定；（3）C2-T2 组：颈椎后路固定。C3-C6 组 27 例，Subaxial-T2 组 24 例，C2-T2 组 12 例。将随访时间最短 12 个月作为纳入标准。在三组患者中测量 C0-2、C2-7 后凸角、矢状垂直轴（SVA）、C2 斜率、C7 斜率、T1 斜率、颈椎斜率、颈部斜率和胸廓入口角（TIA）。比较颈椎矢状位对线情况。
C2-T2 组 C2-7 后凸角增加，C2 斜率降低，TS-CL 增加。C3-C6 组 C2-7 后凸角明显减少，C2 斜率增加，TS-CL 减少。Subaxial-T2 组 C2-7 后凸角明显增加，C2 斜率降低。TS-CL 角无明显变化。
在伴有颈椎失稳的颈椎退行性疾病中，我们推荐使用 C2-T2 固定方法，可获得理想的 C2-7 后凸角、SVA 在正常范围内和最佳的颈痛残疾指数（NDI）结果。
