Schneider Daniel, Gandhi Shashank V, Ward Max, White Timothy G, Brown Ethan D L, Pennington Zach, Zimering Jeffrey, Latefi Ahmad, Rekate Harold, Sciubba Daniel M, Lo Sheng-Fu Larry
Department of Neurological Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, NY, USA.
Texas Back Institute, Plano, TX, USA.
Global Spine J. 2025 Feb 20:21925682251323220. doi: 10.1177/21925682251323220.
Retrospective Cohort.
Craniovertebral instability can arise from various congenital or acquired conditions, but definitive management often requires craniocervical fusion. This study evaluates whether postoperative clivo-axial angle (CXA) can predict distal junctional failure in patients undergoing craniocervical fusion. While postoperative alignment of the head and cervical spine can be quantified via the CXA, it is unclear whether the CXA can predict distal junctional failure.
All patients undergoing craniocervical decompression and fusion (CCF) for craniovertebral instability between 2012 and 2023 at a single institution were identified. Patients experiencing adjacent segment disease (ASD) were identified and compared to those without said pathology based on CXA, Grabb-Oakes line (pBC2), and the presence of cervical kyphosis, cervical disc degeneration, or subluxation on pre- and postoperative imaging. Statistical analysis included Shapiro-Wilk tests for normality, followed by independent t-tests or Mann-Whitney U tests with FDR adjusted values as appropriate, and univariable logistic regression.
71 patients were included, of whom ten (14.3%) developed distal junctional kyphosis and 3 (4.3%) developed cervical spondylolisthesis. The median postoperative CXA was significantly lower in non-ASD patients (144° [IQR: 140-148°] vs 158° [IQR: 153-162°]; < .001) and logistic regression showed that each 10° degree increase in CXA was associated with a 6.7-fold higher odds of ASD.
We found craniocervical alignment, as assessed by CXA, independently predicted distal junctional disease in patients undergoing craniocervical fusion, possibly due to low preoperative CXA in these patients. Large increases in CXA may contribute to postoperative instrumentation failure.
回顾性队列研究。
颅颈不稳定可由多种先天性或后天性疾病引起，但最终治疗通常需要颅颈融合术。本研究评估术后斜坡-枢椎角（CXA）是否能预测接受颅颈融合术患者的远端交界区失败。虽然头部和颈椎的术后对线可通过CXA进行量化，但尚不清楚CXA是否能预测远端交界区失败。
确定2012年至2023年在单一机构接受颅颈减压融合术（CCF）治疗颅颈不稳定的所有患者。识别出发生相邻节段疾病（ASD）的患者，并根据CXA、格拉布-奥克斯线（pBC2）以及术前和术后影像学检查中是否存在颈椎后凸、颈椎间盘退变或半脱位，与无上述病变的患者进行比较。统计分析包括用于正态性检验的夏皮罗-威尔克检验，随后根据情况进行独立t检验或曼-惠特尼U检验以及经FDR校正值检验，还有单变量逻辑回归分析。
纳入71例患者，其中10例（14.3%）发生远端交界区后凸，3例（4.3%）发生颈椎滑脱。非ASD患者术后CXA中位数显著更低（144°[四分位间距：140 - 148°] 对比158°[四分位间距：153 - 162°]；P <.001），逻辑回归显示CXA每增加10°，ASD发生几率高6.7倍。
我们发现，通过CXA评估的颅颈对线情况可独立预测接受颅颈融合术患者的远端交界区疾病，可能是因为这些患者术前CXA较低。CXA大幅增加可能导致术后内固定失败。
