Mei Jun, Wang Zhiqiang, Tian Xuefeng, Liu Qingqing, Sun Lin, Liu Qiang
Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China.
Department of orthopedics, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China; Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
World Neurosurg. 2025 Jan;193:770-780. doi: 10.1016/j.wneu.2024.10.067. Epub 2024 Nov 12.
The subsidence of vertebral body replacement may occur after anterior cervical corpectomy and fusion (ACCF), which may lead to cervical kyphosis, spinal cord compression, and neurological dysfunction. The authors aim to investigate the risk factors for early subsidence of 3D-printed artificial vertebral body (3D-PAVB) after ACCF surgery and to provide guidance for clinical practice.
A retrospective analysis was conducted on the data of consecutive patients with cervical spondylosis who underwent ACCF surgery at Bethune Hospital of Shanxi from 2017 to 2020. The statistical data included age, gender, disease type, body mass index, surgical segment, vertebral height, Cobb angle, and Hounsfield unit (HU) values of the vertebral body and endplate. The clinical efficacy of the surgery was evaluated using Visual Analog Scale (VAS), Japanese Orthopedic Association (JOA), and Neck Disability Index (NDI). Follow-up data, such as VAS, JOA, NDI, and Cobb angle, were obtained using a repeated-measures analysis of variance analysis. Univariate analysis was conducted to identify the factors contributing to the early subsidence of the 3D-PAVB, and independent risk factors were determined using logistic regression. The HU value was analyzed using the receiver operating characteristic curve and the area under the curve to predict the subsidence of the 3D-PAVB.
A total of 66 patients were included in the study, of which 19 patients experienced subsidence of 3D-PAVB, resulting in an incidence rate of 28.8%. The postoperative JOA, VAS, and NDI scores showed significant improvement in both the subsidence and nonsubsidence groups. Upon conducting univariate analysis, significant differences were observed between the 2 groups in terms of age, diabetes, smoking, and lower vertebral computed tomography (CT) values. The average HU value of the subsidence group (251.39 ± 52.615, n = 19) was significantly lower than that of the nonsubsidence group (317.06 ± 73.587, n = 47, P < 0.01). Multivariate analysis revealed that smoking and HU of the lower vertebra were independent risk factors for 3D-PAVB subsidence, with an area under the curve of 0.772 and an optimal threshold of 272 for HU (sensitivity 78.9% and specificity 74.5%).
The occurrence of early subsidence of 3D-PAVB post ACCF surgery is influenced by 2 independent risk factors: smoking and low HU. To predict the likelihood of this outcome, it is advisable to consider smoking history and measure CT HU value prior to surgery. A lower CT HU value is indicative of a greater risk of subsidence.
颈椎前路椎体切除融合术（ACCF）后可能发生椎体置换下沉，这可能导致颈椎后凸、脊髓受压和神经功能障碍。作者旨在研究ACCF手术后3D打印人工椎体（3D-PAVB）早期下沉的危险因素，为临床实践提供指导。
对2017年至2020年在山西白求恩医院接受ACCF手术的连续性颈椎病患者的数据进行回顾性分析。统计数据包括年龄、性别、疾病类型、体重指数、手术节段、椎体高度、Cobb角以及椎体和终板的Hounsfield单位（HU）值。采用视觉模拟量表（VAS）、日本骨科协会（JOA）评分和颈部功能障碍指数（NDI）评估手术的临床疗效。使用重复测量方差分析获得随访数据，如VAS、JOA、NDI和Cobb角。进行单因素分析以确定导致3D-PAVB早期下沉的因素，并使用逻辑回归确定独立危险因素。利用受试者工作特征曲线和曲线下面积分析HU值，以预测3D-PAVB的下沉情况。
本研究共纳入66例患者，其中19例发生3D-PAVB下沉，发生率为28.8%。术后JOA、VAS和NDI评分在下沉组和未下沉组均有显著改善。单因素分析显示，两组在年龄、糖尿病、吸烟以及下位椎体计算机断层扫描（CT）值方面存在显著差异。下沉组的平均HU值（251.39±52.615，n = 19）显著低于未下沉组（317.06±73.587，n = 47，P < 0.01）。多因素分析显示，吸烟和下位椎体的HU是3D-PAVB下沉的独立危险因素，曲线下面积为0.772，HU的最佳阈值为272（敏感性78.9%，特异性74.5%）。
ACCF手术后3D-PAVB早期下沉的发生受吸烟和低HU这两个独立危险因素的影响。为预测这种结果的可能性，建议在手术前考虑吸烟史并测量CT HU值。较低的CT HU值表明下沉风险更大。
