Ni Jiajun, Yuan Lei, Yan Shi, Xian Siming, Chen Zhongqiang, Li Weishi, Zeng Yan
1Department of Orthopedics, Peking University Third Hospital, Beijing.
2Beijing Key Laboratory of Spinal Disease Research, Beijing.
J Neurosurg Spine. 2025 Feb 7;42(4):470-480. doi: 10.3171/2025.1.SPINE241396. Print 2025 Apr 1.
Postoperative neurological deficits are a significant concern for surgeons during spinal deformity correction surgery. Preoperative identification of high-risk patients can help ensure that appropriate measures are taken to minimize the risk of neurological deficits during these procedures. Previous studies have shown that patients with large Cobb angles or deformity angular ratios (DARs) are at higher risk for postoperative neurological deficits. However, some curves with similar Cobb angles and DARs may exhibit significantly different risks of neurological deficits during surgery. Existing methods for evaluating the degree of deformity cannot fully or accurately reflect the degree of spinal deformity. The aim of this study was to determine whether the deformity angular distance ratio (DADR) can reliably assess the neurological risks of patients undergoing three-column osteotomy (3CO).
A consecutive series of 266 patients with a deformity apex at T1-L1 who underwent 3CO at a single academic center from December 2010 to January 2024 were included in the study. Preoperative radiograph measurements were used to calculate DAR and DADR. Binary logistic regression was used to model the relationship between DADR and postoperative neurological deficits. Receiver operating characteristic analysis and the area under the curve (AUC) were used to assess the performance of the model.
The 266 patients had a median (IQR) age of 48.0 (30.0-60.0) years, with 128 (48.1%) females and 138 (51.9%) males. The incidence of postoperative neurological deficits was 11.3% in this series of patients. Among patients undergoing 3CO, sagittal DADR (OR 1.086, 95% CI 1.045-1.129; p < 0.001) and total DADR (OR 1.080, 95% CI 1.046-1.116; p < 0.001) were associated with an increased incidence of postoperative neurological deficits. A total DADR > 30.4 or a sagittal DADR > 26.4 were associated with a 30% incidence of postoperative neurological deficits, which increased to 50% when the total DADR reached 41.4 or the sagittal DADR exceeded 36.6. The overall predictive performances of sagittal DADR (AUC 0.781) and total DADR (AUC 0.799) for postoperative neurological deficits were comparable and considered to be good.
In patients undergoing 3CO for severe spinal deformities, the DADR can be used to quantify the severity of the deformity, which is strongly correlated with the risk of postoperative neurological deficits. Patients with a total DADR > 30.4 or a sagittal DADR > 26.4 are at much higher risk for developing new neurological deficits after surgery.
术后神经功能缺损是脊柱畸形矫正手术中外科医生极为关注的问题。术前识别高危患者有助于确保采取适当措施，以尽量降低这些手术过程中神经功能缺损的风险。既往研究表明，Cobb角大或畸形角比（DAR）的患者术后发生神经功能缺损的风险更高。然而，一些具有相似Cobb角和DAR的脊柱侧弯在手术期间可能表现出显著不同的神经功能缺损风险。现有的评估畸形程度的方法不能完全或准确地反映脊柱畸形的程度。本研究的目的是确定畸形角距离比（DADR）是否能够可靠地评估接受三柱截骨术（3CO）患者的神经风险。
本研究纳入了2010年12月至2024年1月在单一学术中心接受3CO手术的266例畸形顶点位于T1-L1的连续患者。术前通过X线片测量来计算DAR和DADR。采用二元逻辑回归对DADR与术后神经功能缺损之间的关系进行建模。采用受试者工作特征分析和曲线下面积（AUC）评估模型的性能。
266例患者的年龄中位数（IQR）为48.0（30.0-60.0）岁，其中女性128例（48.1%），男性138例（51.9%）。本系列患者术后神经功能缺损的发生率为11.3%。在接受3CO的患者中，矢状面DADR（OR 1.086，95%CI 1.045-1.129；p<0.001）和总DADR（OR 1.080，95%CI 1.046-1.116；p<0.001）与术后神经功能缺损发生率增加相关。总DADR>30.4或矢状面DADR>26.4与30%的术后神经功能缺损发生率相关，当总DADR达到41.4或矢状面DADR超过36.6时，这一发生率增至50%。矢状面DADR（AUC 0.781）和总DADR（AUC 0.799）对术后神经功能缺损的总体预测性能相当，且被认为良好。
在接受3CO治疗严重脊柱畸形的患者中，DADR可用于量化畸形的严重程度，其与术后神经功能缺损的风险密切相关。总DADR>30.4或矢状面DADR>26.4的患者术后发生新的神经功能缺损的风险要高得多。
