Lee Dong-Ho, Cho Sung Tan, Kang Hyun Wook, Park Sehan, Hwang Chang Ju, Cho Jae Hwan
Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Orthopedic Surgery, Seoul Seonam Hospital, Seoul, Republic of Korea.
Spine J. 2025 Apr;25(4):749-755. doi: 10.1016/j.spinee.2024.11.002. Epub 2024 Nov 27.
Cervical myelopathy originating from high cervical pathology is typically managed through stabilization constructs, with the most common options being atlantoaxial fusion (AAF) and occipitocervical fusion (OCF). However, a well-established comparison of the 2 techniques in terms of clinical and radiological outcomes has not been made.
Compare the surgical outcomes of AAF and OCF with a minimum follow-up period of 2 years.
Retrospective cohort study.
A total of 64 patients who underwent AAF (n=46) and OCF (n=18) to treat cervical myelopathy were retrospectively reviewed.
Neck pain Visual Analogue Scale (VAS), Neck Disability Index (NDI), Japanese Orthopedic Association (JOA) scores and postoperative complications were assessed as clinical outcomes. For the radiological outcomes, cervical sagittal parameters including C0-2 lordosis, C2-7 lordosis, C0-7 lordosis, neck range of motion (ROM), C2-7 sagittal vertical axis, C2 sagittal tilt, T1 slope, chin brow vertical angle and McGregor slope were evaluated.
Continuous variables between AAF and OCF were compared using either the Mann-Whitney U test or an independent T-test. The Wilcoxon signed-rank test was utilized to compare variables across preoperative, 1-month postoperative, and final follow-up periods.
Both the AAF and OCF groups did not show any significant differences in the total NDI score, VAS for neck pain, and JOA score when comparing preoperative and postoperative evaluations. However, at 1 month postoperatively (AAF group, 2.63; OCF group, 8.00: p=.006) and final follow-ups (AAF group, 3.08; OCF group, 7.82: p=.003), the OCF group showed a significant decline in the lifting function compared to the AAF group. Furthermore, the decrease in neck ROM was significantly more severe in the OCF group compared to the AAF group (AAF group, -6.4°; OCF group, -20.1°: p=.010).
The OCF has the potential to limit neck movement and impede lifting capabilities after the surgery. Hence, the AAF is advisable over the OCF, especially for younger individuals or those involved in strenuous physical work.
源于高位颈椎病变的脊髓型颈椎病通常通过稳定结构进行治疗，最常见的选择是寰枢椎融合术（AAF）和枕颈融合术（OCF）。然而，尚未对这两种技术在临床和影像学结果方面进行充分的比较。
比较寰枢椎融合术（AAF）和枕颈融合术（OCF）的手术结果，随访期至少为2年。
回顾性队列研究。
回顾性分析了64例行寰枢椎融合术（n = 46）和枕颈融合术（n = 18）治疗脊髓型颈椎病的患者。
将颈部疼痛视觉模拟量表（VAS）、颈部功能障碍指数（NDI）、日本骨科协会（JOA）评分和术后并发症作为临床结果进行评估。对于影像学结果，评估颈椎矢状位参数，包括C0-2前凸、C2-7前凸、C0-7前凸、颈部活动范围（ROM）、C2-7矢状垂直轴、C2矢状倾斜、T1斜率、颏眉垂直角和麦格雷戈斜率。
使用曼-惠特尼U检验或独立t检验比较寰枢椎融合术（AAF）和枕颈融合术（OCF）之间的连续变量。采用威尔科克森符号秩检验比较术前、术后1个月和最终随访期间的变量。
比较术前和术后评估时，寰枢椎融合术（AAF）组和枕颈融合术（OCF）组在总NDI评分、颈部疼痛VAS评分和JOA评分方面均无显著差异。然而，在术后1个月（寰枢椎融合术组，2.63；枕颈融合术组，8.00：p = 0.006）和最终随访时（寰枢椎融合术组，3.08；枕颈融合术组，7.82：p = 0.003），枕颈融合术组与寰枢椎融合术组相比，提升功能显著下降。此外，与寰枢椎融合术组相比，枕颈融合术组颈部活动范围的减小明显更严重（寰枢椎融合术组，-6.4°；枕颈融合术组，-20.1°：p = 0.010）。
枕颈融合术（OCF）有可能限制术后颈部活动并妨碍提升能力。因此，与枕颈融合术相比，寰枢椎融合术更可取，特别是对于年轻个体或从事繁重体力劳动的人。
