Zheng Bin, Zhu Zhenqi, Liang Yan, Yu Panfeng, Guo Chen, Liu Haiying
Spine Surgery, Peking University People's Hospital, Beijing, China.
Spine Surgery, Peking University People's Hospital, Beijing, China.
World Neurosurg. 2025 Jul;199:124069. doi: 10.1016/j.wneu.2025.124069. Epub 2025 May 12.
To investigate the association between cervical subcutaneous fat thickness, sagittal alignment parameters, and clinical outcomes following laminoplasty in patients with cervical spondylotic myelopathy (CSM).
A total of 131 patients with CSM who underwent single-door cervical laminoplasty between January 2021 and June 2023 were retrospectively analyzed, with an average follow-up period of 14.02 ±1.45 months. Subcutaneous fat thickness at the C5 vertebral level and skin-to-lamina distance were measured. Demographic characteristics, cervical sagittal parameters, surgical details, and postoperative outcomes were collected. Interobserver reliability was assessed using intraclass correlation coefficient. Binary logistic regression and receiver operating characteristic curve analyses were conducted to identify predictors of postoperative axial symptoms.
Patients with greater subcutaneous fat thickness exhibited higher body mass index, greater body weight, shorter cervical length, smaller C2-C7 Cobb angles, higher T1 slope, and more severe paraspinal muscle fatty infiltration (all P < 0.05). The average of follow-up time is 14.02 ±1.445 months. There are no differences in final Japanese Orthopaedic Association and visual analog scale follow-up. But thicker subcutaneous fat patients have a higher incidence of postoperative axial symptoms (P = 0.02). Subcutaneous fat thickness was identified as the strongest independent predictor of axial symptoms (B = 0.828, P = 0.002), with receiver operating characteristic analysis showing moderate predictive ability (area under the curve = 0.64) and an optimal cutoff value of 1.357 cm.
Greater cervical subcutaneous fat thickness is associated with abnormal sagittal alignment and increased risk of postoperative axial symptosms after laminoplasty. Subcutaneous fat thickness may serve as a practical localized predictor to optimize surgical planning and postoperative management in CSM patients.
探讨脊髓型颈椎病（CSM）患者椎板成形术后颈椎皮下脂肪厚度、矢状位对线参数与临床疗效之间的关联。
回顾性分析2021年1月至2023年6月期间接受单开门颈椎椎板成形术的131例CSM患者，平均随访时间为14.02±1.45个月。测量C5椎体水平的皮下脂肪厚度和皮肤至椎板的距离。收集人口统计学特征、颈椎矢状位参数、手术细节和术后结果。使用组内相关系数评估观察者间的可靠性。进行二元逻辑回归和受试者工作特征曲线分析，以确定术后轴性症状的预测因素。
皮下脂肪厚度较大的患者表现出更高的体重指数、更大的体重、更短的颈椎长度、更小的C2-C7 Cobb角、更高的T1斜率以及更严重的椎旁肌脂肪浸润（所有P<0.05）。平均随访时间为14.02±1.445个月。末次随访时日本骨科协会评分和视觉模拟量表评分无差异。但皮下脂肪较厚的患者术后轴性症状发生率较高（P=0.02）。皮下脂肪厚度被确定为轴性症状的最强独立预测因素（B=0.828，P=0.002），受试者工作特征分析显示其具有中等预测能力（曲线下面积=0.64），最佳截断值为1.357 cm。
颈椎皮下脂肪厚度增加与矢状位对线异常以及椎板成形术后轴性症状风险增加相关。皮下脂肪厚度可作为一个实用的局部预测指标，以优化CSM患者的手术规划和术后管理。
