Duke Spine Division, Departments of Neurological and Orthopaedic Surgery, Duke School of Medicine, Durham, NC, 27710, USA.
Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, NY, USA.
Acta Neurochir (Wien). 2024 Nov 22;166(1):471. doi: 10.1007/s00701-024-06376-5.
Adult cervical deformity (ACD) surgery is more frequently being performed in frail patients. Although surgical outcomes are largely successful, there remains significant risk of poor outcomes. The ideal length of fusion constructs in these patients remains debatable.
Patients undergoing cervical fusion for ACD with lower instrumented vertebra (LIV) at T4-or-above, with clinical and radiographic data from baseline (BL) to 2 years (2Y) were stratified by CD-modified frailty index into not frail (NF), frail (F) and severely frail (SF) categories. Deformity was classified by Kim et al. criteria. Means comparisons tests were used to assess differences between both groups. Logistic regression analyses were used to analyze associations between frailty categories, lower instrumented vertebra (LIV) and outcomes.
286 patients (Age: 57.3 ± 10.9 years, BMI: 28.9 ± 6.4 kg/m2, CCI: 0.84 ± 1.26). 47% of patients were female. 32.2% of patients were NF, 50.3% F and 17.5% SF. By deformity, 66% were focal kyphosis (FK), 12% were flatneck, and 22% were cervicothoracic. Only FK type differed between NF and F/SF patients (39.2 vs 73.6%, p = 0.005). At baseline (BL), differences in age, BMI, CCI and deformity were not significant. F/SF patients had longer LOS (p = 0.018) and higher rates of distal junctional kyphosis/failure (DJK/F) at 2 years. Controlling for baseline disability, F and SF patients were more likely to experience poor outcomes at 2 years with C7 compared with more distal LIVs. The risk for poorer outcomes was not significant when comparing LIVs within the upper thoracic spine. Similar trends were seen performing sub-analyses specifically comparing F vs SF patients.
Frail patients are at risk for poor outcomes following ACD surgery due to their comorbidities. These patients appear to be at even greater risk for poor outcomes with a lower instrumented vertebra proximal to T1.
成人颈椎畸形（ACD）手术在体弱患者中越来越常见。尽管手术结果大多是成功的，但仍存在不良结果的显著风险。这些患者的理想融合结构长度仍存在争议。
将接受颈椎融合术治疗 T4 或以上下位固定椎体（LIV）的 ACD 患者，根据 CD 改良虚弱指数分为非虚弱（NF）、虚弱（F）和严重虚弱（SF）组。畸形分类采用 Kim 等人的标准。采用均值比较检验比较两组之间的差异。采用逻辑回归分析分析虚弱分类、下位固定椎体（LIV）与结果之间的关系。
286 例患者（年龄：57.3±10.9 岁，BMI：28.9±6.4kg/m2，CCI：0.84±1.26）。47%的患者为女性。32.2%的患者为 NF，50.3%为 F，17.5%为 SF。根据畸形类型，66%为局灶性后凸（FK），12%为平颈，22%为颈胸段。只有 NF 和 F/SF 患者之间 FK 类型存在差异（39.2%比 73.6%，p=0.005）。在基线（BL）时，年龄、BMI、CCI 和畸形差异无统计学意义。F/SF 患者 LOS 较长（p=0.018），2 年时远端交界性后凸/失败（DJK/F）发生率较高。在控制基线残疾的情况下，与更远处的 LIV 相比，F 和 SF 患者在 2 年时 C7 更有可能出现不良结局。当比较上胸椎内的 LIV 时，不良结果的风险并不显著。在比较 F 与 SF 患者的亚分析中也出现了类似的趋势。
由于合并症，虚弱患者在 ACD 手术后发生不良结局的风险增加。这些患者在 T1 以下的下位固定椎体近端出现不良结局的风险更高。
